Modification of HEART Pathway for Patients With Chest Pain: A Korean Perspective

Area of Science:

• Cardiology
• Emergency Medicine
• Clinical Risk Stratification

Background:

• The HEART pathway aids in identifying low-risk patients with chest pain.
• Accurate risk stratification is crucial for timely emergency department discharge.

Purpose of the Study:

• To modify and evaluate the HEART pathway for chest pain patients in a Korean population.
• To assess the impact of adjusting the obesity BMI threshold on MACE risk identification.

Main Methods:

• Prospective enrollment of 1,304 chest pain patients.
• Modification of the HEART pathway using a 30 kg/m² obesity threshold instead of 25 kg/m².
• Primary outcome: Major Adverse Cardiac Event (MACE) within 30 days.

Main Results:

• The modified HEART pathway identified 37.3% of patients as low-risk.
• A lower incidence of MACE was observed in the low-risk group identified by the modified pathway (0.8% vs 1.6%).
• The modified pathway demonstrated high sensitivity (98.8%) and NPV (99.2%) for MACE detection.

Conclusions:

• The modified HEART pathway, utilizing Korean-specific BMI cut-offs, enhances the accurate identification of low-risk patients.
• This adaptation facilitates safer and more precise early discharge decisions for chest pain patients in Korea.