An end-user's guide to the HEART score and pathway

• Published in: The American journal of emergency medicine 2017-09, Vol.35 (9), p.1350-1355
• Main Authors: Long, Brit, MD, Oliver, Joshua, MD, Streitz, Matthew, MD, Koyfman, Alex, MD
• Format: Article
• Language: English
• Subjects: Acute Coronary Syndrome - complications; Acute Coronary Syndrome - diagnosis; Acute coronary syndromes; Biomarkers; Biomarkers - blood; Calcium-binding protein; Cardiovascular disease; Chest; Chest pain; Chest Pain - diagnosis; Chest Pain - etiology; Clinical decision making; Coronary vessels; Decision Making; EKG; Electrocardiography; Emergency; Emergency medical care; Emergency medical services; Emergency Service, Hospital; HEART; Heart attacks; Humans; Infarction; Morbidity; Myocardial infarction; Myocardial Infarction - complications; Myocardial Infarction - diagnosis; Pain; Pathway; Patients; Physicians; Practice Guidelines as Topic; Risk; Risk Assessment; Risk Factors; Score; Severity of Illness Index; Shared decision making; Studies; Troponin; Troponin - blood
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2017.03.047

Abstract 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.