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

Abstract

Chest pain is a common presenting symptom in the emergency department (ED). The HEART (history, electroencephalogram [ECG], age, risk factors, and troponin I) score, with addition of troponin at 3h, helps to determine appropriate risk stratification of the patients. This study evaluated the utility of the HEART pathway as a decision aid designed for risk stratification of patients with acute-onset chest pain for early and safe disposition. This was a prospective observational study done in a tertiary care center. Focused history, 12-lead ECG, and baseline troponin I level on arrival and at hour 3 were recorded. Subjects were classified as low risk (HEART score 0-3) or high risk (HEART score≥4). Patients with a HEART score of 0-3 with negative troponin I at 3h were discharged and were followed up for major adverse cardiac events (MACEs) within 30days of ED presentation. A total of 250 patients were screened for the study, of which 151 were included for the final analysis. One hundred and two patients (68%) were male and 54% of patients were younger than 45years. HEART scores of 0 (n=16), 1 (n=43), 2 (n=44), and 3 (n=48) were observed. There was only 1 MACE (0.7%) in 30days after ED discharge in the study population. The mean length of ED stay in the low-risk group was 4.5h. Low-risk patients, as per the HEART pathway, can be discharged safely from the ED, which reduces ED stay and health care resource use.