Short-Term Risk of Adverse Cardiac Events Among Emergency Department Patients Placed in an Observation Unit for Cardiac Testing
Joshua C Reynolds, J Adam Oostema, Charles Sierzant, Kyle Sherwin, Kaitlyn Beels, Alexander Clegg
Journal of Emergency Medicine, February 11, 2025
✅ Conclusion:
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Most EDOU patients had low short-term (72-hour) risk of MACE.
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Low/intermediate HEART scores plus reassuring symptom and troponin profiles identify a very low-risk subgroup.
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These patients may be appropriate for expedited outpatient pathways, reducing unnecessary hospital-based evaluations.
🧪 Methods:
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Design: Retrospective cohort study
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Population: 1,515 ED patients in EDOU (Jan 2022–Jun 2023)
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Primary Outcome: 72-hour MACE
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Secondary Outcomes: Other cardiac events/treatments not included in MACE
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Stratification: Based on HEART score and symptom/troponin profile
📊 Key Results:
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Overall 72-MACE incidence: 1.4% (95% CI: 0.8–2.1%)
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By HEART score:
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Low: 0.7% (95% CI: 0.02–3.9%)
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Intermediate: 1.3% (95% CI: 0.8–2.1%)
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High: 3.8% (95% CI: 0.8–10.6%)
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Low-risk subgroup predictors:
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No highly suspicious symptoms: aOR 0.24 (95% CI: 0.08–0.77)
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Reassuring hs-Troponin-T: aOR 0.15 (95% CI: 0.04–0.58)
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Lowest-risk subgroup (favorable symptoms + troponin):
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72-MACE incidence: 0.7% (95% CI: 0.3–1.4%)
Reynolds, J.C., Oostema, J.A., Sierzant, C., Sherwin, K., Beels, K., Clegg, A., Chassee, T.P., Cummings, T.M., Deveau, J.P., Mehalko, A. and Mullennix, S.C., 2025. Short-Term Risk of Adverse Cardiac Events Among Emergency Department Patients Placed in an Observation Unit for Cardiac Testing. Journal of Emergency Medicine.