The High‐Sensitivity HEART Pathway Safely Reduces Hospitalizations Regardless of Sex or Race in a Multisite Prospective US Cohort

ABSTRACT Background The high‐sensitivity HEART pathway (hs‐HP) risk stratifies emergency department (ED) patients with chest pain. It is unknown if its safety and effectiveness vary by sex or race. Methods We conducted a subgroup analysis of the hs‐HP implementation study, a pre−post interrupted time series at five US EDs. The pre‐implementation period (January 2019 to April 2020) utilized the traditional HEART pathway with contemporary troponin (Siemens) and the post‐implementation period (November 2020 to February 2022) used the hs‐HP using hs‐cTnI (Beckman Coulter). Patients were risk‐stratified using the hs‐HP to rule‐out, observation, and rule‐in groups. Safety and effectiveness outcomes were 30‐day all‐cause mortality or myocardial infarction (MI) and 30‐day hospitalization. Results Twenty‐six thousand and one hundred twenty‐six patients were accrued (12 317 pre‐ and 13 809 post‐implementation), of which 35.3% were non‐White and 52.7% were female. Among 9703 patients with complete hs‐HP assessments, 48.6% of White and 55.4% of non‐White patients were ruled‐out (p