Unlocking the Potential of the Heart Pathway: Predicting Mace and Facilitating Nurse–Physician Collaboration in Chest Pain Unit Publisher Pubmed



Behpour Z^{1, 2} ; Amirsardari Z^{3, 4} ; Aghakhani H⁵ ; Zanganehfar M¹ ; Khaleghparast S⁵ ; Shabani F⁵ ; Bakhshandeh H¹ ; Sadeghipour P¹ Show Affiliations
Source: Critical Pathways in Cardiology Published:2025

Abstract

Background and Objective: The HEART pathway serves as a tool for predicting major adverse cardiac events (MACE) among patients presenting with acute chest pain, aiding in the early discharge of low-risk patients and reducing unnecessary cardiac investigations. This study aimed to evaluate physician–nurse reliability of the HEART pathway and investigate the efficacy of HEART pathway to predict 3-month MACE in patients with acute chest pain. Methods: We conducted a prospective study on 97 patients experiencing acute chest pain. A team of 3 professionals, a nurse, a cardiology resident, and a cardiology attending physician, performed risk stratification. We assessed interrater reliability among the raters as well as explored 3-month MACE outcomes. Results: Excellent pairwise agreements were found between the raters. Overall agreement among raters was excellent, with an intraclass correlation coefficient of 0.84 (95% confidence interval: 0.73–0.97). The HEART pathway score exhibited strong predictive power (area under curve: 0.85) for 3-month MACE. At a cutoff score of 4, sensitivity, specificity, and negative predictive values were 87.5%, 58.9%, and 95.8%, respectively. Conclusions: The HEART pathway score effectively predicts 3-month MACE in patients with acute nontraumatic chest pain. Moreover, the high agreement among the attending physician, the resident physician, and the nurse suggests that nurses could use this tool, potentially reducing the workload on physicians. Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.