ToolsCalculators
HEART Pathway for Early Discharge in Acute Chest Pain
HEART score plus serial troponin to select chest-pain patients for early discharge.
HEART Pathway for Early Discharge in Acute Chest Pain
History
ECG
Age
Risk factors
HTN, hypercholesterolaemia, diabetes, obesity (BMI>30), smoking (current or <3mo), family history, or known atherosclerotic disease.
Initial troponin
Result0 points
Low risk (0-3 points): with a second troponin negative at 3 hours, early discharge without stress testing or angiography is reasonable.
- HEART score
- 0
- Risk category
- Low risk
When to use
- Risk-stratifying emergency department patients with possible acute coronary syndrome to decide between early discharge and further inpatient work-up, combined with a 0- and 3-hour troponin protocol.
Formula
Sum of History, ECG, Age, Risk factors, and Troponin, each scored 0-2 (total 0-10). Low risk 0-3, moderate 4-6, high 7-10. The HEART Pathway additionally requires a non-elevated troponin at both 0 and 3 hours to classify a patient as low risk for early discharge.
Pearls and pitfalls
- In the HEART Pathway randomised trial, low-risk patients discharged early had a 30-day death/MI rate under 1%, with fewer objective cardiac tests than usual care.
- The Risk-factor item counts traditional atherosclerotic risk factors and known atherosclerotic disease, not merely their presence in the chart.