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Utility of HEART Pathway in Identifying Low-Risk Chest Pain in Emergency Department

Dipanjan Halder1, Roshan Mathew1, Nayer Jamshed1

  • 1Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India.

The Journal of Emergency Medicine
|January 24, 2021
PubMed

Insights

The HEART pathway safely identifies low-risk chest pain patients for early emergency department discharge. This approach reduces hospital stays and healthcare resource use for patients with chest pain.

Area of Science:

  • Emergency Medicine
  • Cardiology
  • Clinical Decision Support

Background:

  • Chest pain is a frequent emergency department (ED) complaint.
  • The HEART score (History, ECG, Age, Risk Factors, Troponin) aids in risk stratification.
  • Adding a 3-hour troponin measurement refines patient assessment.

Purpose of the Study:

  • To assess the HEART pathway's effectiveness as a decision aid.
  • To evaluate the risk stratification of acute chest pain patients.
  • To determine the safety and efficiency of early patient disposition from the ED.

Main Methods:

  • Prospective observational study in a tertiary care center.
  • Collected focused history, ECG, and troponin I at baseline and 3 hours.
  • Classified patients into low (HEART score 0-3) and high (HEART score ≥4) risk groups.

Main Results:

  • 151 patients included in final analysis; 68% male, 54% under 45 years.
  • Low-risk patients (HEART score 0-3) with negative troponin at 3 hours were discharged.
  • Only 1 major adverse cardiac event (0.7%) occurred within 30 days post-discharge; mean ED stay for low-risk was 4.5 hours.

Conclusions:

  • The HEART pathway enables safe discharge of low-risk chest pain patients from the ED.
  • Utilizing the HEART pathway reduces emergency department length of stay.
  • This strategy conserves healthcare resources while ensuring patient safety.
Abstract

Keywords:
acute coronary syndromechest painemergencymajor adverse cardiac event

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