HIP fracture Accelerated surgical TreaTment And Care tracK 2 Trial

Patients suffering a hip fracture with an acute myocardial injury are at substantial risk for mortality. The current standard of care is to delay surgery for those patients while additional tests and potential treatments are implemented with the intention of minimizing the risk of post-operative complications. However, there is no RCT data demonstrating that cardiac stabilization and surgical delay are beneficial for these patients. Among the patients with an acute myocardial injury randomized to standard care in the HIP ATTACK-1 trial mortality was more than doubled as compared to patients that underwent accelerated surgery.

There exists a strong biological rationale for how accelerated surgical treatment of a hip fracture and an acute myocardial injury may lower a patient’s risk of death. There is also encouraging data from HIP ATTACK-1 trial suggesting that early surgery for a hip fracture reduces a patient’s risk of mortality. Moreover, the HIP ATTACK-1 trial demonstrated the feasibility of a trial comparing accelerated medical assessment and surgery versus standard care in those patients. Currently, most patients wait more than 24 hours to have surgery after diagnosis of a hip fracture when there is an ongoing myocardial injury. The need for a large adequately powered trial to settle the issue in a clear way that will drive subsequent practice is compelling.

This is the first large trial that may change the paradigm to postpone surgery in patients suffering acute myocardial injuries before surgery, proposing a novel approach to reverse myocardial injury through expedited surgical care.