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RAPID-CPU: a prospective study on implementation of the ESC 0/1-hour algorithm and safety of discharge after rule-out of myocardial infarction
- Source :
- European Heart Journal. Acute Cardiovascular Care
- Publication Year :
- 2019
-
Abstract
- Background: Although the value of fast diagnostic protocols in suspected acute coronary syndrome has been validated, there is insufficient real world evidence including patients with lower pre-test probability, atypical symptoms and confounding comorbidities. The feasibility, efficacy and safety of European Society of Cardiology (ESC) 0/1 and 0/3-hour algorithms using high-sensitivity troponin T were evaluated in a consecutive cohort with suspected acute coronary syndrome. Methods: During 12 months, 2525 eligible patients were enrolled. In a pre-implementation period of 6 months, the prevalence of protocols, disposition, lengths of emergency department stay and treatments were registered. Implementation of the 0/1-hour protocol was monitored for another 6 months. Primary endpoints comprised the change of diagnostic protocols and 30-day mortality after direct discharge from the emergency department. Results: Use of the ESC 0/1-hour algorithm increased by 270% at the cost of the standard 0/3-hour protocol. After rule-out (1588 patients), 1309 patients (76.1%) were discharged directly from the emergency department, with an all-cause mortality of 0.08% at 30 days (one death due to lung cancer). Median lengths of stay were 2.9 (1.9–3.8) and 3.2 (2.7–4.4) hours using a single high-sensitivity troponin T below the limit of detection (5 ng/L) at presentation and the ESC 0/1-hour algorithm, respectively, as compared to 5.3 (4.7–6.5) hours using the ESC 0/3-hour rule-out protocol ( PConclusion: Implementation of the ESC 0/1-hour algorithm is feasible and safe, is associated with shorter emergency department stay than the ESC 0/3-hour protocol, and an increase in discharge rates. Trial registration: ClinicalTrials.gov , Unique identifier: NCT03111862.
- Subjects :
- Male
Time Factors
Myocardial Infarction
Comorbidity
030204 cardiovascular system & hematology
Critical Care and Intensive Care Medicine
Efficiency, Organizational
real world evidence
0302 clinical medicine
Clinical Protocols
Prevalence
030212 general & internal medicine
Myocardial infarction
Prospective Studies
Prospective cohort study
Original Scientific Papers
Societies, Medical
Aged, 80 and over
biology
Troponin T
General Medicine
Middle Aged
Patient Discharge
Europe
Cardiology
Female
Safety
Cardiology and Cardiovascular Medicine
Emergency Service, Hospital
Algorithms
Adult
medicine.medical_specialty
Acute coronary syndrome
Real world evidence
03 medical and health sciences
Internal medicine
medicine
Humans
Acute Coronary Syndrome
Aged
business.industry
Surrogate endpoint
Length of Stay
medicine.disease
Troponin
high-sensitivity troponin
biology.protein
Feasibility Studies
business
Value (mathematics)
Subjects
Details
- ISSN :
- 20488734
- Volume :
- 9
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- European heart journal. Acute cardiovascular care
- Accession number :
- edsair.doi.dedup.....410a5631515344ec5b02bcf5b72c4728