HEART パスウェイの実装
HEART パスウェイ: 業務、研究、教育の間のギャップを埋める
調査の概要
状態
詳細な説明
毎年、胸痛を訴える何百万人もの患者が救急科 (ED) を受診します。 胸痛を訴えるED患者の半数以上がさらなる検査を受けるために入院します。 高い検査率にも関わらず、最終的に急性冠症候群(ACS)と診断されるのは胸痛患者の10人に1人未満であり、そのコストは推定年間130億ドルに達します。 急性胸痛に対する現在の治療パターンでは、入院や心臓検査などの医療システムのリソースを、最も効果が期待できる患者に集中させることができていない。
HEART Pathway は、臨床的意思決定支援と 2 つの連続トロポニン測定を組み合わせたもので、客観的な心臓検査 (負荷検査または血管造影) なしで安全に退院できる胸痛患者を特定するために開発されました。 これまでの遡及的および観察的研究により、HEART パスウェイの使用により、許容可能な低い有害事象率を維持しながら、心臓検査が 20% 以上減少することが証明されています。 私たちは現在、有効性を判断するために HEART Pathway を「現実世界」の臨床現場に統合することを目指しています。
この提案の目標は、研究、教育、医療システム運営の間のギャップを埋める革新的なコラボレーションを構築し、より効果的かつ効率的に患者ケアを提供することです。 この提携の先駆者は、ウェイク フォレスト バプティスト ヘルス (WFBH) での心臓血管ケアの提供に HEART パスウェイを統合することで、急性胸痛患者のケアの質の向上を目指しています。 このプロジェクトは私たちのこれまでの取り組みを基礎としており、米国の学術医療センターの教育と運営上の強みを活用して、ケア提供を改善するための取り組みを広めるモデルを提供します。
研究の種類
入学 (実際)
連絡先と場所
研究場所
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North Carolina
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Winston-Salem、North Carolina、アメリカ、27157
- Wake Forest Baptist Medical Center
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参加基準
適格基準
就学可能な年齢
健康ボランティアの受け入れ
受講資格のある性別
サンプリング方法
調査対象母集団
説明
包含基準:
- 救急外来(ED)受診時の年齢が21歳以上であること
- 胸部不快感は、患者の評価のために心電図 (ECG) および心臓バイオマーカーを取得する担当医師によって示された急性冠症候群 (ACS) の可能性と一致します。
除外基準:
- 任意の心電図上の隣接する誘導における新たな ST セグメントの上昇 (>/= 1 mV)
研究計画
研究はどのように設計されていますか?
デザインの詳細
- 観測モデル:コホート
- 時間の展望:見込みのある
コホートと介入
グループ/コホート |
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HEART パスウェイの導入後
HEART Pathway 意思決定補助の導入後、胸痛を訴えて救急外来 (ED) を訪れた患者に関するデータが収集されます。
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Pre-HEART パスウェイの実装
HEART Pathway の意思決定支援を実施する前に、胸痛を訴えて救急外来 (ED) を訪れた患者に関するデータが収集されます。
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この研究は何を測定していますか?
主要な結果の測定
結果測定 |
時間枠 |
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入院率
時間枠:救急外来受診から 30 日後
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救急外来受診から 30 日後
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協力者と研究者
捜査官
- 主任研究者:Simon A Mahler, MD, MS、Wake Forest Baptist Medical Center
出版物と役立つリンク
一般刊行物
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- Mahler SA, Hiestand BC, Goff DC Jr, Hoekstra JW, Miller CD. Can the HEART score safely reduce stress testing and cardiac imaging in patients at low risk for major adverse cardiac events? Crit Pathw Cardiol. 2011 Sep;10(3):128-33. doi: 10.1097/HPC.0b013e3182315a85.
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- Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE Jr, Chavey WE 2nd, Fesmire FM, Hochman JS, Levin TN, Lincoff AM, Peterson ED, Theroux P, Wenger NK, Wright RS, Smith SC Jr, Jacobs AK, Adams CD, Anderson JL, Antman EM, Halperin JL, Hunt SA, Krumholz HM, Kushner FG, Lytle BW, Nishimura R, Ornato JP, Page RL, Riegel B; American College of Cardiology; American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction); American College of Emergency Physicians; Society for Cardiovascular Angiography and Interventions; Society of Thoracic Surgeons; American Association of Cardiovascular and Pulmonary Rehabilitation; Society for Academic Emergency Medicine. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-Elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction) developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine. J Am Coll Cardiol. 2007 Aug 14;50(7):e1-e157. doi: 10.1016/j.jacc.2007.02.013. No abstract available. Erratum In: J Am Coll Cardiol. 2008 Mar 4;51(9):974.
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- Mahler SA, Miller CD, Hollander JE, Nagurney JT, Birkhahn R, Singer AJ, Shapiro NI, Glynn T, Nowak R, Safdar B, Peberdy M, Counselman FL, Chandra A, Kosowsky J, Neuenschwander J, Schrock JW, Plantholt S, Diercks DB, Peacock WF. Identifying patients for early discharge: performance of decision rules among patients with acute chest pain. Int J Cardiol. 2013 Sep 30;168(2):795-802. doi: 10.1016/j.ijcard.2012.10.010. Epub 2012 Oct 30.
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- Ashburn NP, Snavely AC, Paradee BE, O'Neill JC, Stopyra JP, Mahler SA. Age differences in the safety and effectiveness of the HEART Pathway accelerated diagnostic protocol for acute chest pain. J Am Geriatr Soc. 2022 Aug;70(8):2246-2257. doi: 10.1111/jgs.17777. Epub 2022 Apr 5.
- Husain I, Mahler SA, Hiestand BC, Miller CD, Stopyra JP. The Impact of Accelerated Diagnostic Protocol Implementation on Chest Pain Observation Unit Utilization. Crit Pathw Cardiol. 2022 Mar 1;21(1):7-10. doi: 10.1097/HPC.0000000000000254.
- Smith LM, Ashburn NP, Snavely AC, Stopyra JP, Lenoir KM, Wells BJ, Hiestand BC, Herrington DM, Miller CD, Mahler SA. Identification of very low-risk acute chest pain patients without troponin testing. Emerg Med J. 2020 Nov;37(11):690-695. doi: 10.1136/emermed-2020-209698. Epub 2020 Aug 4.
- Stopyra J, Snavely AC, Hiestand B, Wells BJ, Lenoir KM, Herrington D, Hendley N, Ashburn NP, Miller CD, Mahler SA. Comparison of accelerated diagnostic pathways for acute chest pain risk stratification. Heart. 2020 Jul;106(13):977-984. doi: 10.1136/heartjnl-2019-316426. Epub 2020 Apr 8.
- Mahler SA, Lenoir KM, Wells BJ, Burke GL, Duncan PW, Case LD, Herrington DM, Diaz-Garelli JF, Futrell WM, Hiestand BC, Miller CD. Safely Identifying Emergency Department Patients With Acute Chest Pain for Early Discharge. Circulation. 2018 Nov 27;138(22):2456-2468. doi: 10.1161/CIRCULATIONAHA.118.036528.
- Mahler SA, Burke GL, Duncan PW, Case LD, Herrington DM, Riley RF, Wells BJ, Hiestand BC, Miller CD. HEART Pathway Accelerated Diagnostic Protocol Implementation: Prospective Pre-Post Interrupted Time Series Design and Methods. JMIR Res Protoc. 2016 Jan 22;5(1):e10. doi: 10.2196/resprot.4802.
研究記録日
主要日程の研究
研究開始 (実際)
一次修了 (実際)
研究の完了 (実際)
試験登録日
最初に提出
QC基準を満たした最初の提出物
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QC基準を満たした最後の更新が送信されました
最終確認日
詳しくは
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胸痛の臨床試験
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Dexa Medica Group完了