cliot (version 1.0.0)

heart_pathway_early_discharge: HEART Pathway for Early Discharge in Acute Chest Pain

Description

Calculates the HEART Pathway result to identify patients with acute chest pain who can be safely discharged from the Emergency Department. The pathway combines the HEART Score (History, ECG, Age, Risk Factors, Initial Troponin) with a serial 3-hour troponin measurement.

Usage

heart_pathway_early_discharge(history_score, ecg_score, age,
                              risk_factors_score, initial_troponin_score,
                              troponin_3h_negative)

Value

A list containing:

HEART_Score

The calculated HEART score (Range 0-10).

Pathway_Result

Classification as "Low Risk" or "Not Low Risk".

Recommendation

Guidance on discharge vs. admission.

Arguments

history_score

Numeric (0-2). History suspicion: 0=Slightly, 1=Moderately, 2=Highly suspicious.

ecg_score

Numeric (0-2). ECG findings: 0=Normal, 1=Non-specific repolarization, 2=Significant ST deviation.

age

Numeric. Patient age in years. (Score calculated internally: <45=0, 45-64=1, >=65=2).

risk_factors_score

Numeric (0-2). Risk Factors: 0=None, 1=1-2 factors, 2=3+ factors or History of CAD.

initial_troponin_score

Numeric (0-2). Initial Troponin: 0=<=limit, 1=1-2x limit, 2=>2x limit.

troponin_3h_negative

Numeric (0 or 1). Is the 3-hour repeat troponin negative/normal? (1 = Yes, 0 = No/Not Done).

References

Mahler SA, Riley RF, Hiestand BC, et al. The HEART Pathway randomized trial: identifying emergency department patients with acute chest pain for early discharge. Circ Cardiovasc Qual Outcomes. 2015;8(2):195-203. doi:10.1161/CIRCOUTCOMES.114.001384

Examples

# Example 1: Low Risk Candidate
# Hx Moderate(1), ECG Normal(0), Age 40(0), Risk Factors 1(1), Trop 0(0), 3h Trop Neg(1)
# HEART Score = 2. Pathway: Low Risk.
heart_pathway_early_discharge(1, 0, 40, 1, 0, 1)

# Example 2: High Risk (Score > 3)
# Hx High(2), ECG Non-spec(1), Age 50(1), Risk Factors 2(2), Trop 0(0), 3h Trop Neg(1)
# HEART Score = 6. Pathway: Not Low Risk.
heart_pathway_early_discharge(2, 1, 50, 2, 0, 1)