Accelerated diagnostic pathways (ADPs) have been designed to identify low risk chest pain patients in the emergency department. This review article discusses the ASPECT score, the ADAPT score, the EDACS score, the HEART score and the HEART pathway. These ADPs have been validated in various studies, and aid the emergency provider with identifying the low risk chest pain patient that is appropriate for discharge home, while at the same time highlighting those patients who would benefit from further in patient work up. These approaches should be pared with patient input and shared decision making strategies.