Stratification of low-risk ischemic chest pain: An umbrella review for its integration into advanced nursing practice in emergency departments
Type de matériel :
16
ObjectiveThe objective was to conduct an umbrella review examining tools for stratifying patients presenting with chest pain suspected of low-risk non-ST-elevation myocardial infarction (NSTEMI) in the emergency department.MethodFor this umbrella review, systematic reviews matching the inclusion criteria were sought across three databases. Articles underwent a selection process and were assessed on their methodological quality and level of evidence in accordance with the recommendations outlined in the Joanna Briggs Institute Manual for Evidence Synthesis. According to Pieper et al., the degree of overlap between primary studies was calculated. Evidence from 8 systematic reviews was then extracted using a standardized tool.ResultsThe low-risk HEART score, with the use of highly sensitive troponin, made it possible to discharge safely more than one-third of patients with a major adverse cardiac event rate of less than 1% (0.8%). This tool also demonstrated high sensitivity (sensitivity 97% CI [88; 99]) and superiority for the mortality and myocardial infarction components. Its negative predictive value was 0.99, making this score an ideal tool for excluding major adverse cardiac events in the studied population. The characteristics of the EDAC score were also highly effective. However, further investigation of its extrinsic characteristics and an in-depth analysis of clinical heterogeneity is necessary.ConclusionThis summary emphasizes the safety and diagnostic accuracy of the low-risk HEART score. After ruling out differential diagnoses, stratification of low-risk ischemic chest pain using the HEART score could support the safety of an innovative care model integrating advanced nursing practice in emergency departments.
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