Take-Home Messages from New Chest Pain Guidelines, with Martha Gulati, MD

Although it is among the most frequent reasons for patients to present to emergency departments, chest pain has been an abstract idea lacking a specific definition or consensus clinical guidance. Now, as the result of a 4-year undertaking with endorsements from professional societies representing multiple specialties, the American College of Cardiology (ACC) and American Heart Association (AHA) Joint Committee on Clinical Practice Guidelines has released a guideline for the evaluation and diagnosis of chest pain.

A 99-page document simultaneously published in Circulation and in the Journal of the American College of Cardiology, the report covers a range of topics including the definition of chest pain, shared-decision making, recommendations on imaging modalities, and more. Chaired by Martha Gulati, MD, MS, professor of cardiology at the University of Arizona, the guidelines are based on data obtained from a comprehensive literature search performed from November 11, 2017, to May 1, 2020, and was reviewed by reviewers nominated by ACC, the American College of Emergency Physicians, AHA, American Society of Echocardiography, American Society of Nuclear Cardiology, CHEST, Society for Academic Emergency Medicine, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance as well as 39 individual content reviewers.

“Everyone should know the symptoms that can indicate a heart attack and that calling 911 is the most important thing to do to save their life or that of their loved one experiencing chest pain,” said Gulati, former academic division chief of the division of cardiology at the University of Arizona, in a statement from the AHA. “This standard approach provides clinicians with the guidance to better evaluate patients with chest pain, identify patients who may be having a cardiac emergency and then select the right test or treatment for the right patient.”

Not including the abstract, introduction, and preamble, the guidelines are broken down into 5 sections detailing guidance for initial evaluation, cardiac testing general consideration, choosing the right pathway with patient-centric algorithms, evaluation of patients with stable chest pain, and evidence gaps and future research considerations. The beginning of the statement also outlines 10 key take-home messages for evaluating and diagnosing chest pain. For more insight into these take-home points, Practical Cardiology’s editorial staff sat down with Gulati for further perspective.