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An end-user's guide to the HEART score and pathway
Brit Long1, Joshua Oliver1, Matthew Streitz1
1San Antonio Military Medical Center, Department of Emergency Medicine, 3841 Roger Brooke Dr, Fort Sam Houston, TX 78234, United States.
Insights
The HEART score and pathway effectively risk stratify emergency department patients with chest pain. This approach aids in safely discharging many patients while ensuring accurate assessment for acute coronary syndrome (ACS).
Area of Science:
- Emergency Medicine
- Cardiology
Background:
- Chest pain is a frequent reason for emergency department visits.
- The HEART score and pathway offer a validated method for risk stratification and patient discharge.
Purpose of the Study:
- To review the essential elements of the HEART score and pathway.
- To discuss current and future applications and considerations for the HEART score and pathway.
Main Methods:
- Evaluation of the HEART score components: History, ECG, Age, Risk Factors, Troponin.
- Analysis of the HEART pathway's clinical utility in chest pain management.
- Review of literature on HEART score accuracy and impact on patient outcomes.
Main Results:
- The HEART score accurately categorizes patients based on key clinical data.
- The HEART pathway demonstrates high sensitivity for major adverse cardiac events (MACE).
- Physician gestalt, follow-up, and shared decision-making are crucial considerations.
Conclusions:
- The HEART pathway provides reliable risk stratification for chest pain patients.
- Careful consideration of all HEART score components is vital for appropriate use.
- Future iterations may integrate additional patient-specific factors.
Background:
Chest pain accounts for a significant percentage of emergency department (ED) presentations. The HEART score and pathway have demonstrated an ability to appropriately risk stratify and discharge from the ED a significant proportion of patients.
Objective:
This review evaluates vital components of the HEART score and pathway, while discussing important considerations for current and future use.
Discussion:
Chest pain is a common ED presentation, and several conditions associated with chest pain result in patient morbidity and mortality. One major disease is acute coronary syndrome (ACS). Despite the fear associated with this disease, it accounts for a minority of patients with chest pain in the ED. Emergency physicians rarely miss myocardial infarction (MI) or ACS, with miss rates<1%. Many have sought a score and pathway that allow physicians to safely and reliably risk stratify patients. The HEART score and pathway have revolutionized chest pain evaluation, as they can risk stratify a significant number of patients accurately into separate categories based on history, electrocardiogram (ECG), troponin, age, and risk factors while displaying high sensitivity for MACE. Several intricacies must be considered in the use of this score including risk factors, ECG, troponin, age, history, gestalt, follow up, borderline score, and shared decision making. The HEART pathway can supplement clinician decision making.
Conclusions:
Appropriate use of the HEART pathway reliably risk stratifies patients. Physicians must consider several key components when utilizing the HEART pathway, and future directions may incorporate other patient factors.