VCU Emergency Medicine Journal Club

To make participants more informed readers of medical literature

Citation Date:

Mahler SA, et al. The HEART Pathway randomized trial: identifying emergency department patients with acute chest pain for early discharge. Circ Cardiovasc Qual Outcomes. 2015; 8: 195–203
Wake Forest School of Medicine, Winston-Salem NC
Published: March 2015
Reviewed: June 2015
Journal Club: July 2015
P (Patient/Population)
I (Intervention)
C (control)
O (outcome) / Primary:
Secondary (etc):
T (timeline)

Article Specific Questions:

1. What is the HEART Pathway? What are the components of the HEART Score?

Answer:

Journal Club Coordinator Commentary:

1. Is the primary outcome patient-focused or disease-focused? Is this an important outcome to us in the ED? Why did the authors not choose MACE as their primary outcome?

Answer:

Journal Club Coordinator Commentary:

2. If the hospital had forced physicians to use the HEART pathway in the treatment group (per protocol), would this have changed the conclusions of this study? Would there have been any adverse events with this approach? Why didn’t they do this?

Answer:

Journal Club Coordinator Commentary:

3. What is a Mann-Whitney U test? When is it used? Why was it used in this study?

Answer:

Journal Club Coordinator Commentary:

4. The authors conclude that the HEART pathway “significantly” decreased cardiac testing at 30 days (their primary outcome). What does “significant” mean here? Look at the p-value for the primary outcome. If you round it…are you still “significant”? Can you figure out what the confidence intervals are around the point estimate of 12%?

Answer:

Journal Club Coordinator Commentary:

5. How similar is the patient population studied to VCUs? How does this affect the applicability of the pathway?

Answer:

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Journal Club Coordinator Commentary:

6. What does the HEART Pathway add over serial troponins alone? What are some of the limitations of this study? The authors report the study was not powered to detect differences in MACE. Does this matter?

Answer:

Journal Club Coordinator Commentary: