Objectives
The Improved Assessment of Chest pain Trial (IMPACT) pathway is an accelerated strategy
for the assessment of emergency patients presenting with suspected acute coronary
syndrome (ACS). The objective of this study was to report outcomes for Aboriginal
and Torres Strait Islander patients deemed low-, intermediate-, or high-risk according
to this pathway.
Design
This was a prospective observational trial conducted between November 2017 and December 2019.
Setting
Regional hospital in Far North Queensland.
Participants
Aboriginal and Torres Strait Islander people presenting to the Emergency Department
with suspected ACS were asked to participate. Participants were stratified as low-,
intermediate- or high-risk of ACS according to the IMPACT pathway. High-and intermediate
risk patients were managed according to the IMPACT pathway. Management of low-risk
patients included additional inpatient cardiac testing, which was not part of the
original IMPACT pathway.
Main Outcome Measures
The primary outcome was acute coronary syndrome within 30-days. Secondary outcomes
included length of stay and prevalence of objective testing.
Results
A total of 155 participants were classified as either at low-risk (n=18 11.6%), intermediate-risk
(n=87 56.1%), or high-risk (n=50 32.3%) of ACS. Thirty-day (30-day) ACS occurred in
29 (18.6%) patients, which included 26 (52.0%) high-risk patients and three (3.4%)
intermediate-risk patients. No patients in the low-risk group were diagnosed with
ACS during their index presentation or by 30-days. Median hospital length-of-stay
was 11.9 hours (interquartile range [IQR] 5.3–20.2 hrs) for low- and 15.5 hours (IQR
5.9–29.2 hrs) for intermediate-risk patients.
Conclusion
The IMPACT pathway, which has been associated with reduced LOS in other settings,
could be safely implemented for patients of Aboriginal and Torres Strait Islander
origin, classifying two-thirds as low- or intermediate risk. However, a clinically
significant proportion of Aboriginal and Torres Strait Islander patients experience
cardiac events, which supports the need to provide early objective testing for coronary
artery disease.
Keywords
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Article info
Publication history
Published online: March 22, 2022
Accepted:
February 18,
2022
Received in revised form:
February 15,
2022
Received:
November 28,
2021
Identification
Copyright
Crown Copyright © 2022 Published by Elsevier B.V. on behalf of Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). All rights reserved.
