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Cardiac Imaging and Diagnostics · Journal article
Catheterization and Cardiovascular Interventions · August 4, 2026
Encouraging direction, but not yet definitive.
This is a single-centre retrospective cohort evaluation of an ambulatory HEART score–guided pathway with urgent outpatient CTCA for troponin-negative, moderate-risk chest pain patients. The pathway achieved low admission rates (9.0% from clinic, 0.4% prior to appointment) and no 6-month mortality, demonstrating feasibility and safety in a UK tertiary setting, but lacks a control comparator and prospective design required to establish superiority over inpatient investigation.
Retrospective cohort study / service evaluation. Adults presenting to a UK tertiary NHS hospital with suspected cardiac chest pain, normal troponin, and HEART score 4–6; those with valid CTCA contraindications were excluded from the analysis.. Intervention: Ambulatory HEART score–guided pathway with urgent outpatient CTCA within 96 hours and same-day clinic review. n = 222. Single UK tertiary centre.
222 of 349 patients met referral criteria for the ambulatory pathway (per-protocol cohort) 215 patients underwent CTCA; 99 patients (44.1%) had no obstructive coronary disease on imaging alone 87 patients (39.2%) received final diagnosis of angina; 50 patients (22.5%) had disease significant enough for direct revascularisation
No mortality recorded after 6 months of follow-up
This service evaluation suggests that an ambulatory HEART score–guided pathway with rapid outpatient CTCA may safely avoid hospital admission for moderate-risk chest pain without increases in early adverse events. However, the lack of a control group and single-centre setting mean clinicians should view this as supportive evidence for feasibility rather than definitive proof of superiority, and local validation is advisable before adoption.
Single-centre observational cohort demonstrating feasibility and safety of an ambulatory chest pain pathway with low adverse events, but lacks a comparator group and prospective design to establish practice-changing efficacy.
As stated by the source record.
Quoted from the source exactly as published.
This service evaluation suggests that an ambulatory HEART score–guided pathway with rapid outpatient CTCA may safely avoid hospital admission for moderate-risk chest pain without increases in early adverse events. However, the lack of a control group and single-centre setting mean clinicians should view this as supportive evidence for feasibility rather than definitive proof of superiority, and local validation is advisable before adoption.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
BACKGROUND: Suspected cardiac chest pain is a common cause for hospital admission. In busy acute NHS hospitals, patients with suspected cardiac chest pain, normal Troponin levels, and no evidence of acute coronary syndrome are often admitted for invasive angiography or CT coronary angiography (CTCA). This has a significant impact on the length of stay, patient flow, and bed capacity. A timely ambulatory pathway for these patients to undergo urgent outpatient CTCA would avoid admission. AIMS: The aim was to design an ambulatory pathway for rapid investigation of patients with troponin-negative chest pain, as a safe alternative to admission. METHODS: A trustwide guideline was implemented, which emphasized the use of the heart score to risk-stratify patients, and determine suitability for referral to our new service. Those scoring 4-6 were deemed appropriate for the pathway and returned within 96 h to undergo CTCA, then attend the chest pain hot clinic for review. In the original HEART pathway trial, these "moderate risk" patients were admitted. A unique feature of the pathway was the agreement for non-cardiologists to book the CTCA directly, without cardiology input. This facilitated a very short time to diagnosis from the point of discharge, when compared to similar "rapid access chest pain" pathways. RESULTS: A total of 349 patients were reviewed in the hot clinic between July 4, 2024, and December 31, 2024. Of these, 222 met the referral criteria and were included in the per-protocol analysis. A CTCA was performed for 215 patients, with a minority having a valid contraindication. This alone was sufficient to exclude obstructive coronary disease in 99 of those scanned (44.1%). After completion of the investigation, 87 patients (39.2%) received a final diagnosis of angina, whilst 50 patients (22.5%) had coronary disease significant enough to proceed directly to revascularization. With regards to safety outcomes, 20 patients (9.0%) were admitted from the clinic, and there was only one case of a cardiovascular-related admission prior to the appointment (0.4%), with no associated mortality after 6 months. CONCLUSION: Our center's experience demonstrates the feasibility and safety of managing patients presenting with moderate risk chest pain via an urgent ambulatory care pathway. There are significant benefits to this strategy relating to admission avoidance, and our low adverse event rate suggests that this is a safe model when compared to inpatient investigation.
Taken from the source record, never inferred. Follow any of these and new work involving them reaches your briefing.