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    Patent Pending

    HEART Pathway for Early Discharge in Acute Chest Pain

    Identifies emergency department patients with acute chest pain for early discharge.

    INSTRUCTIONS

    Use in patients ≥21 years old presenting with symptoms suggestive of ACS. Do not use if new ST-segment elevation ≥1 mm or other new EKG changes, hypotension, life expectancy less than 1 year, or noncardiac medical/surgical/psychiatric illness determined by the provider to require admission.

    When to Use
    Pearls/Pitfalls
    Why Use

    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.
    Slightly suspicious
    0
    Moderately suspicious
    +1
    Highly suspicious
    +2
    Normal
    0
    Non-specific repolarization disturbance
    +1
    Significant ST depression
    +2
    <45
    0
    45-64
    +1
    ≥65
    +2
    No known risk factors
    0
    1-2 risk factors
    +1
    ≥3 risk factors or history of atherosclerotic disease
    +2
    ≤normal limit
    0
    1-3x normal limit
    +1
    >3x normal limit
    +2

    Result:

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    Next Steps
    Evidence
    Creator Insights
    Dr. Simon A. Mahler

    About the Creator

    Dr. Simon A. Mahler, MD, is an associate professor of emergency medicine at Wake Forest Baptist Health in Winston-Salem, North Carolina. He is board certified in emergency medicine and is also the chief medical officer of Decision Point Informatics, LLC. Dr. Mahler’s research interests include decision support in chest pain patients presenting to the emergency department.

    To view Dr. Simon A. Mahler's publications, visit PubMed

    Are you Dr. Simon A. Mahler? Send us a message to review your photo and bio, and find out how to submit Creator Insights!
    MDCalc loves calculator creators – researchers who, through intelligent and often complex methods, discover tools that describe scientific facts that can then be applied in practice. These are real scientific discoveries about the nature of the human body, which can be invaluable to physicians taking care of patients.
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