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

Oct 2, 2026

Uploaded by Adam

2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR clinical practice guideline provides clinician recommendations and diagnostic algorithms for assessing chest pain in adults. It outlines a structured, evidence-based approach to risk stratification and diagnostic workup, integrating cost–value considerations in testing and encouraging shared decision-making with patients. The guideline is grounded in a comprehensive search of studies published in English across major medical databases, supplemented by relevant research through April 2021.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages87

Reading Time3 h 39 min

AccessFree to download

Top 10 Take-Home Messages for the Evaluation and Diagnosis of Chest Pain

Preamble

1. Introduction

1.1. Methodology and Evidence Review

1.2. Organization of the Writing Committee

1.3. Document Review and Approval

1.4. Scope of the Guideline

1.5. Abbreviations

2. Initial Evaluation

2.1. History

2.2. Physical Examination

2.3. Diagnostic Testing

Downloaded from [http://ahajournals.org by on October](http://ahajournals.org by on October) 15, 2024 Circulation AHA/ACC CLINICAL PRACTICE GUIDELINE 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/ SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines Writing Committee Members* Martha Gulati, MD, MS, FACC, FAHA, Chair†; Phillip D. Levy, MD, MPH, FACC, FAHA, Vice Chair†; Debabrata Mukherjee, MD, MS, FACC, FAHA, Vice Chair†; Ezra Amsterdam, MD, FACC†; Deepak L. Bhatt, MD, MPH, FACC, FAHA†; Kim K. Birtcher, MS, PharmD, AACC‡; Ron Blankstein, MD, FACC, MSCCT§; Jack Boyd, MD†; Renee P. Bullock-Palmer, MD, FACC, FAHA, FASE, FSCCT†; Theresa Conejo, RN, BSN, FAHA‖; Deborah B. Diercks, MD, MSc, FACC¶; Federico Gentile, MD, FACC\#; John P. Greenwood, MBChB, PhD, FSCMR, FACC**; Erik P. Hess, MD, MSc†; Steven M. Hollenberg, MD, FACC, FAHA, FCCP††; Wael A. Jaber, MD, FACC, FASE‡‡; Hani Jneid, MD, FACC, FAHA§§; José A. Joglar, MD, FAHA, FACC‡; David A. Morrow, MD, MPH, FACC, FAHA†; Robert E. O’Connor, MD, MPH, FAHA†; Michael A. Ross, MD, FACC†; Leslee J. Shaw, PhD, FACC, FAHA, MSCCT† 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 evidencebased 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. Key Words: AHA Scientific Statements ◼ 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 *Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information.†ACC/AHA Representative.‡ACC/AHA Joint Committee on Clinical Practice Guidelines Liaison. §Society of Cardiovascular Computed Tomography Representative. ‖Lay Patient Representative. ¶Society for Academic Emergency Medicine Representative. \#Former ACC/AHA Joint Committee member; current member during the writing effort. **Society for Cardiovascular Magnetic Resonance Representative.††American College of Chest Physicians Representative.‡‡American Society of Echocardiography Representative. §§Task Force on Performance Measures, Liaison. ACC/AHA Joint Committee on Clinical Practice Guidelines Members, see page e420 . The American Heart Association requests that this document be cited as follows: Gulati M, Levy PD, Mukherjee D, Amsterdam E, Bhatt DL, Birtcher KK, Blankstein R, Boyd J, Bullock-Palmer RP, Conejo T, Diercks DB, Gentile F, Greenwood JP, Hess EP, Hollenberg SM, Jaber WA, Jneid H, Joglar JA, Morrow DA, O’Connor RE, Ross MA, Shaw LJ.

FAQs

Who is the guideline intended to help evaluate and diagnose chest pain for?

The guideline provides recommendations for clinicians assessing and diagnosing chest pain in adult patients.

What is the core structure of the guideline’s approach?

It presents an evidence-based approach to risk stratification and diagnostic workup, including cost–value considerations and shared decision-making with patients.

How was evidence gathered for the guideline?

A comprehensive literature search covered randomized and nonrandomized trials, observational studies, registries, and reviews published in English across major databases, with additional studies considered through April 2021.

Oct 2, 2026

Uploaded by Adam