ABSTRACT The proposed trial, HIP ATTACK-2, seeks to improve the outcomes of thousands of patients who present to the hospital with a hip fracture and concomitant acute heart injury. Acute heart injury is characterized by an elevated serum troponin; this heart injury is often asymptomatic but can be identified in up to 20% of hip fracture patients prior to surgery. These patients have a much worse prognosis than patients with no heart injury (i.e., 24% versus 8% 90-day mortality, respectively). Despite the magnitude of this problem, standard medical management has made little progress in improving the outcomes of these patients. The objective of the HIP ATTACK-2 trial is to confirm the previous post-hoc subgroup findings by comparing accelerated surgery (<6 hours) to standard care in hip fracture patients presenting with elevated serum troponin. This multicenter, parallel group randomized controlled trial will address three specific aims: 1) to determine if accelerated surgery reduces the risk of 90-day mortality in hip fracture patients who also have an acute heart injury, 2) to determine if accelerated surgery increases the proportion of patients able to independently ambulate 10 feet at 90-days, 3) to determine if accelerated surgery improves patient-reported quality of life and decreases medical and surgical complications.

NARRATIVE HIP fracture Accelerated surgical TreaTment And Care tracK-2 (HIP ATTACK-2) is a 1,100 patient international randomized controlled trial (RCT) comparing accelerated surgery (<6 hours) to standard care in hip fracture patients with an acute heart injury. We hypothesize that accelerated care will reduce 90-day mortality, improve independent ambulation at 90-days, improve patient-reported quality of life, and decrease complications. This NIAMS application seeks funding to enroll 300 eligible hip fracture patients in the United States to ensure the results of the trial are generalizable to the US healthcare system, and the overall sample size goals are met.