Role of HEART score in evaluating clinical outcomes among emergency department patients with different ethnicities

Abstract

Objective We aimed to examine the role of the HEART (history, EKG, age, risk factors, and troponin) score in the evaluation of six clinical outcomes among three groups of patients in the emergency department (ED). Methods We performed a retrospective observational study among three ED patient groups including White, Black, and Hispanic patients. ED providers used the HEART score to assess the need for patient hospital admission and for emergent cardiac imaging tests (CITs). HEART scores were measured using classification accuracy rates. Performance accuracies were measured in terms of HEART score in relation to four clinical outcomes (positive findings of CITs, ED returns, hospital readmissions, and 30-day major adverse cardiac events [MACE]). Results A high classification accuracy rate (87%) was found for use of the HEART score to determine hospital admission. HEART scores showed moderate accuracy (area under the receiver operating characteristic curve 0.66–0.78) in predicting results of emergent CITs, 30-day hospital readmissions, and 30-day MACE outcomes. Conclusions Providers adhered to use of the HEART score to determine hospital admission. The HEART score may be associated with emergent CIT findings, 30-day hospital readmissions, and 30-day MACE outcomes, with no differences among White, Black, and Hispanic patient populations.

Using HEART2 score to risk stratify chest pain patients in the Emergency Department: an observational study

“…In addition, all patients were expected to follow up within 30 days of discharge from the ED or hospitalization. For patients who had missed information on 30 days follow-up, imputed data were used for the analysis [ 12 ].…”

“…We collected patients’ basic demographics (i.e., age, gender, race/ethnicity) and clinical variables (i.e., patient mode of arrival at ED, insurance type, ED disposition, and total ED length of stay in minutes). A detail explanation of general variables had been reported previously [ 12 ].…”

“…Positive heart catheterization findings refer to performing interventions or recommending further procedures. A detail description on CIT reviewing decisions were reported previously [ 12 ].…”

“…Approximately 37.6% of the patients in this data sample had no follow-up information, and therefore their 30-day MACE outcomes were not observed. We thus manipulated the missing values as previously reported [ 12 ]. Briefly with three different methods: (1) All the missing MACE outcome values are indicated by zero (i.e., no MACE occurred); (2) The relevant data of patients without follow-up records were excluded from the analysis for predicting the MACE outcome; and (3) The missing MACE outcome values were imputed based on the distribution of the outcome among those follow-up patients [ 12 ].…”

“…Such findings might question the value of using traditional HEART scores for risk stratification, given the fact that patients with risks of ACS might already have higher HEART scores despite recent negative cardiac imaging. Since 10–20% of chest pain patients may already have the previous CIT upon presenting to the ED, the current HEART score to determine patients’ ACS risk may bring less value for their chest pain management [ 12 , 13 ]. On the contrary, it may increase the providers’ burden to further admit patients to in-hospital management with the potential redundant cardiac workup.…”