R.E.B.E.L.EM April, 30, 2015 - Post Peer Reviewed By: Anand Swaminathan
What is the HEART Pathway?
The HEART Pathway is a combination of the HEART score with 0 and 3 hour cardiac troponin testing. This is a recently developed decision aid used to identify patients in the emergency department (ED) that are safe for early discharge. There have been several observational studies that have shown using the HEART score can classify >20% of patients with acute chest pain for early discharge while maintaining a negative predictive value (NPV) for major adverse cardiac events (MACE) rate of >99% at 30 days. There have been no real-time, randomized trials comparing the HEART Pathway versus the ACC/AHA recommendations (i.e. usual care), until now...
Image from Mahler SA et al. The HEART Pathway Randomized Trial Identifying Emergency Department Patients With Acute Chest Pain for Early Discharge.
Circ Cardiovasc Qual Outcomes March 2015; 8 (2): 195 – 203.
What is the Clinical Take Home Message of this Study?
It is safe to begin using the HEART Pathway (Non-ischemic ECG, HEART Score, and Troponin testing at 0 and 3 hours) in chest pain patients presenting to the emergency department with suspicion of ACS. Use of the HEART Pathway significantly decreases objective cardiac testing, increases early discharge rates, and cuts median length of stay with a zero MACE rate at 30 days.
http://rebelem.com/is-it-time-to-start-using-the-heart-pathway-in-the-emergency-department/