Skip to main content
construction release_alert
Scholars@Duke will be undergoing maintenance April 11-15. Some features may be unavailable during this time.
cancel
Journal cover image

Outpatient versus observation/inpatient management of emergency department patients rapidly ruled-out for acute myocardial infarction: Findings from the HIGH-US study.

Publication ,  Journal Article
Nowak, RM; Jacobsen, G; Limkakeng, A; Peacock, WF; Christenson, RH; McCord, J; Apple, FS; Singer, AJ; deFilippi, CR
Published in: Am Heart J
January 2021

BACKGROUND: The actual Emergency Department (ED) dispositions of patients enrolled in observational studies and meeting criteria for rapid acute myocardial infarction (AMI) rule-out are unknown. Additionally, their presenting clinical profiles, cardiac testing/treatments received, and outcomes have not been reported. METHODS: Patients in the HIGH-US study (29 sites) that ruled-out for AMI using a high-sensitivity cardiac troponin I 0/1-hour algorithm were evaluated. Clinical characteristics of patients having ED discharge were compared to patients placed in observation or hospital admitted (OBS/ADM). Reports of any OBS/ADM cardiac stress test (CST), cardiac catheterization (Cath) and coronary revascularization were reviewed. One year AMI/death and major adverse cardiovascular event rates were determined. RESULTS: Of the 1,020 ruled-out AMI patients 584 (57.3%) had ED discharge. The remaining 436 (42.7%) were placed in OBS/ADM. Patients with risk factors for AMI, including personal or family history of coronary artery disease, hypertension, previous stroke or abnormal ECG were more often placed in OBS/ADM. 175 (40.1%) had a CST. Of these 32 (18.3%) were abnormal and 143 (81.7%) normal. Cath was done in 11 (34.3%) of those with abnormal and 13 (9.1%) with normal CST. Of those without an initial CST 85 (32.6%) had Cath. Overall, revascularizations were performed in 26 (6.0%) patients. One-year AMI/death rates were low/similar (P = .553) for the groups studied. CONCLUSIONS: Rapidly ruled-out for AMI ED patients having a higher clinician perceived risk for new or worsening coronary artery disease and placed in OBS/ADM underwent many diagnostic tests, were infrequently revascularized and had excellent outcomes. Alternate efficient strategies for these patients are needed.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

January 2021

Volume

231

Start / End Page

6 / 17

Location

United States

Related Subject Headings

  • Troponin I
  • Time Factors
  • Risk Factors
  • Patient Discharge
  • Observational Studies as Topic
  • Myocardial Revascularization
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Kaplan-Meier Estimate
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Nowak, R. M., Jacobsen, G., Limkakeng, A., Peacock, W. F., Christenson, R. H., McCord, J., … deFilippi, C. R. (2021). Outpatient versus observation/inpatient management of emergency department patients rapidly ruled-out for acute myocardial infarction: Findings from the HIGH-US study. Am Heart J, 231, 6–17. https://doi.org/10.1016/j.ahj.2020.10.067
Nowak, Richard M., Gordon Jacobsen, Alexander Limkakeng, William F. Peacock, Robert H. Christenson, James McCord, Fred S. Apple, Adam J. Singer, and Christopher R. deFilippi. “Outpatient versus observation/inpatient management of emergency department patients rapidly ruled-out for acute myocardial infarction: Findings from the HIGH-US study.Am Heart J 231 (January 2021): 6–17. https://doi.org/10.1016/j.ahj.2020.10.067.
Nowak RM, Jacobsen G, Limkakeng A, Peacock WF, Christenson RH, McCord J, et al. Outpatient versus observation/inpatient management of emergency department patients rapidly ruled-out for acute myocardial infarction: Findings from the HIGH-US study. Am Heart J. 2021 Jan;231:6–17.
Nowak, Richard M., et al. “Outpatient versus observation/inpatient management of emergency department patients rapidly ruled-out for acute myocardial infarction: Findings from the HIGH-US study.Am Heart J, vol. 231, Jan. 2021, pp. 6–17. Pubmed, doi:10.1016/j.ahj.2020.10.067.
Nowak RM, Jacobsen G, Limkakeng A, Peacock WF, Christenson RH, McCord J, Apple FS, Singer AJ, deFilippi CR. Outpatient versus observation/inpatient management of emergency department patients rapidly ruled-out for acute myocardial infarction: Findings from the HIGH-US study. Am Heart J. 2021 Jan;231:6–17.
Journal cover image

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

January 2021

Volume

231

Start / End Page

6 / 17

Location

United States

Related Subject Headings

  • Troponin I
  • Time Factors
  • Risk Factors
  • Patient Discharge
  • Observational Studies as Topic
  • Myocardial Revascularization
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Kaplan-Meier Estimate