013 Paramedic HEART scores in the prediction of MACE and AMI. The ambulance cardiac chest pain evaluation in scotland (ACCESS) study

Cooper, Jamie G; Ferguson, James; Donaldson, Lorna A.; Black, Kim M.M.; Davidson, Elaine M.; Horrill, Judith L.; Livock, Kate J.; Lee, Kuan Ken; Anand, Atul; Mills, Nicholas L.; Scott, Neil

doi:10.1136/emermed-2019-rcem.13

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“…Of these, 661 were excluded based on title and/or abstract and 31 studies were scrutinized in full-text. By reading full-text, four articles were not relevant to our study (either assessed the HEART score and not the HEAR or evaluated another rule with similar name) [13–16], and 17 articles were only published as abstract with no full text available [8,17–32]. We tried to communicate with the corresponding authors of the abstracts via email for their published studies in full text, but received only studies that were already included.…”

Section: Resultsmentioning

confidence: 99%

The performance of HEAR score for identification of low-risk chest pain: a systematic review and meta-analysis

Rad

Pirmoradi

Doosti-Irani

et al. 2022

European Journal of Emergency Medicine

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Chest pain is one of the most common presentations to the emergency department (ED) and HEART score (history, ECG, age, risk factors, and cardiac troponin) is recommended for risk stratification. It has been proposed that the sum of four items with no troponin (HEAR score) below 2 can be used safely to lower testing and reduce length of stay. To assess the performance of the HEAR score in hospital and prehospital settings, we performed a systematic review and meta-analysis. English studies on the performance of the HEAR score in patients with acute chest pain were included. They were excluded if data are inaccessible. MEDLINE, Embase, Evidence-Based Medicine Reviews, Scopus, and web of science were searched from 1946 to July 2021. The quality of studies was assessed using Quality Assessment of Diagnostic Accuracy Studies version 2. Acute coronary syndrome or major adverse cardiac events prediction were outcomes of interest. The performance indices with 95% confidence intervals (CIs) were extracted. Inverse variance and the random-effects model were used to report the results. Of the 692 articles on the HEAR score, 10 studies were included in the analysis with 33 843 patients. Studies were at low to moderate risk of bias. Three studies were in prehospital and three were retrospective. The pooling of data on the HEAR score showed that the sensitivity at the HEAR<2, <3, and <4 cutoffs in the ED were 99.03% (95% CI, 98.29–99.77), 97.54% (95% CI, 94.50–100), and 91.80% (95% CI, 84.62–98.98), respectively. The negative predictive values (NPVs) for the above cutoffs were 99.84% (95% CI, 99.72–99.95), 99.75% (95% CI, 99.65–99.85), and 99.57% (95% CI, 99.11–100), respectively. Of note, for the HEAR<2, negative likelihood ratio was 0.07 (95% CI, 0.02–0.12). In the prehospital, at the HEAR<4 cutoff, the pooled sensitivity and NPV were 85.01% (95% CI, 80.56–89.47) and 91.48% (95% CI, 87.10–95.87), respectively. This study showed that in the ED, the HEAR score<2 can be used for an early discharge strategy. Currently, this score cannot be recommended in prehospital setting. Prospero (CRD42021273710).

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Section: Resultsmentioning

confidence: 99%