4.7 Article

2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain

Journal

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
Volume 78, Issue 22, Pages E187-E285

Publisher

ELSEVIER SCIENCE INC
DOI: 10.1016/j.jacc.2021.07.053

Keywords

ACC/AHA Clinical Practice Guidelines; chest pain; angina; coronary artery disease; acute coronary syndrome; myocardial ischemia; myocardial infarction; myocardial injury; noncardiac; accelerated diagnostic pathway; clinical decision pathway; sex differences; troponins; chest pain syndromes; biomarkers; shared decision-making; noncardiac chest pain; cardiac imaging

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This guideline provides recommendations and algorithms for clinicians to assess and diagnose chest pain in adult patients, based on contemporary evidence of risk stratification and diagnostic workup. Cost-value considerations in diagnostic testing have been incorporated, and shared decision-making with patients is recommended.
AIM This clinical practice guideline for the evaluation and diagnosis of chest pain provides recommendations and algorithms for clinicians to assess and diagnose chest pain in adult patients. METHODS A comprehensive literature search was conducted from November 11, 2017, to May 1, 2020, encompassing randomized and nonrandomized trials, observational studies, registries, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, Agency for Healthcare Research and Quality reports, and other relevant databases. Additional relevant studies, published through April 2021, were also considered. STRUCTURE Chest pain is a frequent cause for emergency department visits in the United States. The 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain provides recommendations based on contemporary evidence on the assessment and evaluation of chest pain. This guideline presents an evidence-based approach to risk stratification and the diagnostic workup for the evaluation of chest pain. Cost-value considerations in diagnostic testing have been incorporated, and shared decision-making with patients is recommended.

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