HEART Pathway for Early Discharge in Acute Chest Pain

Patients ≥21 years old presenting in the emergency department with acute chest pain concerning for ACS.

• The HEART Pathway was designed to aid in efficiently evaluating patients with acute chest pain using the previously validated HEART Score.
• Identifies patients who are safe for early discharge versus those who need observation, admission, and potentially emergent cardiology assessment.
• While patients with ischemic changes on EKG or elevated troponin may be classified as low risk using the HEART Pathway, the creators recommend not to rely on the HEART Pathway in cases like this. New elevations in troponin or EKG changes require further workup and should not be deemed low risk.
• The creators of the HEART Pathway recommend against using this clinical decision tool in patients with known coronary artery disease as their disease state puts them at significant increased risk of ACS.
• Designed for patients presenting to the emergency department with chest pain; not tested in already-hospitalized patients with chest pain.

• Chest pain is one of the most common and potentially life-threatening chief complaints in emergency medicine. Many patients presenting with chest pain undergo unnecessarily extensive and costly evaluations to rule out ACS. The HEART Pathway can reduce the number of prolonged and invasive evaluations while maintaining high sensitivity and negative predictive value for ACS.
• Unlike other scoring systems such as TIMI Risk Index or GRACE, the HEART Pathway is designed to predict the likelihood of ACS in the patient presenting to the emergency department with acute chest pain. TIMI and GRACE are used to risk stratify patients who have been diagnosed with ACS.