HEART Score
The HEART pathway is a clinical decision support tool employed to identify patients with low-risk chest pain who are suitable for early discharge without requiring objective cardiac testing. Its efficacy in reducing objective cardiac testing, increasing rates of early discharge, and cutting median length of stay was demonstrated in the Heart Pathway Implementation Trial.10
A score is assigned based on the patient history (H), ECG findings (E), age (A), risk factors (R), and initial troponin (T), which risk stratifies the individual as being low or high risk.
| History |
Highly suspicious Moderately suspicious Slightly or non-suspicious |
2 Points 1 Point 0 Points |
| ECG |
Significant ST depression Non-specific repolarisation changes Normal |
2 Points 1 Point 0 Points |
| Age |
>65 45-65 <45 |
2 Points 1 Point 0 Points |
| Risk factors |
>3 factors or history of CAD 1 or 2 risk factors No risk factors |
2 Points 1 Point 0 Points |
| Troponin |
>3x normal limit 1–3x normal limit Within normal limits |
2 Points 1 Point 0 Points |
| Risk factors: Diabetes mellitus, current or recent (within one month) history of cigarette smoking, hypertension, hyperlipidaemia, family history of CAD, obesity | ||
|
Score 0–3: 2.5% MACE over next 6 weeks. Discharge home. Score 4–6: 20.3% MACE over next 6 weeks. Admit for clinical observation. Score 7–10: 72.7% MACE over next 6 weeks. Early invasive strategies. |
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The HEART Pathway combines the HEART score with 0h and 3h troponin testing.10