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The following is a summary of “Safety and Effectiveness of the High-Sensitivity HEART Pathway Safely Across Age Groups in Patients with Suspected Acute Coronary Syndrome,” published in the April 2025 issue of American Journal of Cardiology by Supples et al.

The high-sensitivity HEART Pathway (hs-HP) is an evidence-based risk stratification tool designed to assess patients from the emergency department presenting with chest pain. While its overall efficacy has been established, its diagnostic performance across distinct age subgroups has not been thoroughly evaluated. This study presented a subgroup analysis from a five-site hs-HP implementation study to assess its effectiveness and safety across varying age demographics.

Prior to implementation (January 2019–April 2020), the traditional HEART Pathway, utilizing contemporary troponin assays, guided risk stratification. Post-implementation (November 2020–February 2022), the hs-HP employed high-sensitivity troponin assays to categorize patients into rule-out, observation, and rule-in groups. Patients were stratified into young (18–45 years), middle-aged (46–64 years), and older (≥65 years) cohorts. Primary outcomes included 30-day hospitalization rates (effectiveness) and 30-day all-cause mortality or MI rates (safety). Multivariable logistic regression analyses were conducted to compare outcomes before and after hs-HP implementation within each age subgroup.

A total of 26,126 patients were included, with 12,317 assessed pre-implementation and 13,809 post-implementation. The cohort was 35.3% non-White and 52.7% female. Following hs-HP implementation, hospitalizations significantly declined across all age groups: by 18.1% among older adults (70.6% pre- vs. 52.5% post-implementation; [aOR] 0.47; 95% [CI], 0.42–0.52), by 18.2% in middle-aged patients (50.0% vs. 31.8%; aOR 0.48; 95% CI, 0.44–0.52), and by 7.5% in younger patients (20.1% vs. 7.6%; aOR 0.69; 95% CI, 0.59–0.76).

Safety outcomes revealed no significant increase in 30-day adverse events across age groups. Among older patients, 30-day mortality or MI rates were 12.9% post-implementation compared to 13.5% pre-implementation (aOR 1.02; 95% CI, 0.89–1.18). For middle-aged patients, rates were 7.0% versus 7.5% (aOR 1.01; 95% CI, 0.87–1.18), and among younger patients, 1.5% versus 2.0% (aOR 1.01; 95% CI, 0.69–1.48).

In conclusion, the implementation of the high-sensitivity HEART Pathway significantly reduced hospitalization rates among ED patients with chest pain across all age groups without compromising patient safety, as evidenced by stable 30-day mortality and MI rates.

Source: ajconline.org/article/S0002-9149(25)00277-2/fulltext