Rapid testing for heart attacks does not reduce length of emergency department stay

A rapid diagnostic pathway for identifying heart attacks in emergency departments (EDs) performed as well as a slower method regarding patient safety, yet it did not decrease the length of time patients spent in the ED or increase direct discharges, according to a large trial. Over 30 million individuals globally visit EDs annually with symptoms suggestive of a heart attack, so rapid and accurate diagnostic methods are crucial for timely treatment while alleviating ED congestion.

The 0/1-hour pathway, devised by researchers from University Hospital Basel and University Hospital Bonn in Switzerland and Germany, combines clinical evaluation with two cardiac troponin measurements taken one hour apart to expedite diagnosis compared to the standard approach of measuring troponin three hours apart. In the PRESC1SE-MI trial, involving 67,624 ED patients presenting with suspected heart attacks at 20 hospitals in 11 countries, the 0/1-hour pathway was found to be noninferior to the 0/3-hour pathway in terms of safety, with 1.1% and 1.2% occurrence of death from any cause or new type 1 myocardial infarction within 30 days, respectively.

However, the median ED length of stay remained unchanged at 309 minutes across both groups. A subsequent meta-analysis of five trials, encompassing 110,933 patient presentations, reinforced the results, establishing that the 0/1-hour pathway provided comparable safety to the standard care without reducing ED length of stay or increasing direct discharge from the ED.