UTILITY OF HEART PATHWAY IN IDENTIFYING LOW-RISK CHEST PAIN IN EMERGENCY DEPARTMENT

Background: 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 3 h, helps to determine appropriate risk stratification of the patients. Objective: This study evaluated the utility of the HEART pathway as a decision aid designed for risk stratification of patients with acuteonset chest pain for early and safe disposition. Methods: 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 3 h were discharged and were followed up for major adverse cardiac events (MACEs) within 30 days of ED presentation. Results: 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 45 years. 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 30 days after ED discharge in the study population. The mean length of ED stay in the low- risk group was 4.5 h. Conclusions: Low-risk patients, as per the HEART pathway, can be discharged safely from the ED, which reduces ED stay and health care resource use. (C) 2020 Elsevier Inc. All rights reserved.