A prospective validation of the HEART score for chest pain patients at the emergency department

Backus, Barbra E.; Six, A. Jacob; Kelder, Johannes C.; Bosschaert, Mike A.R.; Mast, E. Gijs; Mosterd, Arend; Veldkamp, Rolf F.; Wardeh, Alexander J.; Tio, RA; Braam, Richard L.; Monnink, Shj; Tooren, Rob van; Mast, Thomas P.; Akker, F. van den; Cramer, Maarten J.; Poldervaart, Judith M.; Hoes, Arno W.; Doevendans, Pieter A.

doi:10.1016/j.ijcard.2013.01.255

Cited by 445 publications

(484 citation statements)

References 33 publications

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“…The obtained results of our study confirmed that 11% of total patients was in lowrisk group (HEART score 0-3) and had 0% chance for reaching an endpoint (MACE), lower in our study compared with previous studies 2.5% 2 , 0.99% 12 and 1.7% 13 . Based on our results, 48% of total patients was also in intermediate-risk group (HEART score 4-6) and had 14.58% chance for reaching an endpoint (MACE), compared with previous studies, the frequency of patients had chance to reach endpoint in this group were 20.3% 2 , 11.6% 12 and 16.6% 13 .…”

Section: Discussionsupporting

confidence: 88%

“…Based on our results, 48% of total patients was also in intermediate-risk group (HEART score 4-6) and had 14.58% chance for reaching an endpoint (MACE), compared with previous studies, the frequency of patients had chance to reach endpoint in this group were 20.3% 2 , 11.6% 12 and 16.6% 13 . The results of this study showed 17% of total patients was in highrisk group (HEART score 7-10) and had 41.46% chance for reaching an endpoint (MACE), lower in our study compared with previous studies 72% 2 , 65.2% 12 and 50.1% 13 .…”

Section: Discussionsupporting

confidence: 54%

“…The HEART score for patients at the emergency room was presented by BE Backus et al, 11 . The HEART score contains five items (history, ECG, age, risk factors and troponin.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation Efficacy of HEART Score in Prediction of Major Advanced Cardiac Events in Patients with Chest Pain

Bolvardi¹,

Raoufi²,

Vakili³

et al. 2016

Biosci., Biotech. Res. Asia

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Chest pain is one of the most common reasons for admitting patients to the emergency room. The focus of the diagnostic process in chest pain patients at the emergency department is to identify both low and high risk patients for an acute coronary syndrome (ACS). Numerous risk prediction scores have been developed for fast and accurate risk stratification of chest pain in ED, like HEART score that a new ED Chest Pain risk stratification score. In this prospective cohort study, we aimed to evaluate efficacy of HEART score in prediction of 30 days major advanced cardiac events (MACE) in acute chest pain patients. A total of 100 unselected patients presented with acute chest pain at the cardiac emergency department of Emam Reza Hospital in Mashhad, from September 2015 until February 2016. The HEART score was assessed as soon as the first lab results and ECG were obtained. Endpoint was the occurrence of major adverse cardiac events (MACE) within 30 days. After 30-day follow-up, a total of 24 patients (24 %) reached one or more endpoints, AMI was diagnosed in 18 patients (18%), 2 patients (2%) underwent percutaneous coronary intervention (PCI), One (1%) had coronary artery bypass graft (CABG) surgery and 3 (3%) died. Independent predictors of MACE included age (P= 0.001). Hypertension was independent predictor of the combined end point only in female (P= 0.006). Age and troponin were independent predictors of the combined end point in both gender (Age P= 0.032 and Tpi P= 0.000). The average HEART score in the no end point group was 5.42 and in the patients with at least one end point was 7.42 (P=0.000). In low HEART scores (points 0-3), risk of MACE was 0%. In patients with HEART scores 4-6, MACE was diagnosed in 14.58%. In patients with high HEART scores (7-10), MACE occurred in 41.46%. In our study with increasing point of HEART score: sensitivity decreased, specifity increased and Positive predictive value increased.The HEART score helps in making accurate decisions at the emergency room without the use of invasive procedure. The HEART score is an easy, quick and reliable predictor of outcome in acute chest pain patients. It facilitates communication between doctors, especially when discussing the use of limited resources for chest pain patients. In this conditions who have higher HEART score points, choices may appear clear. This analysis suggests that HEART score can identify ED patients with acute chest pain for early discharge, as attention to high risk patients for admission for clinical observation, appropriate treatment including noninvasive testing and/or invasive strategies.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionsupporting

confidence: 54%

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Evaluation Efficacy of HEART Score in Prediction of Major Advanced Cardiac Events in Patients with Chest Pain

Bolvardi¹,

Raoufi²,

Vakili³

et al. 2016

Biosci., Biotech. Res. Asia

View full text Add to dashboard Cite

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“…Several risk scores have been developed, including Thrombolysis in Myocardial Infarction (TIMI); [4][5][6] Global Registry of Acute Coronary Events (GRACE); [7][8][9][10] Fast Revascularisation in Instability in Coronary disease (FRISC); 11 and History, ECG, Age, Risk factors, and Troponin (HEART), 12,13 to identify which patients with chest pain of cardiac etiology are at higher risk for worse cardiovascular outcomes and mortality. These scores are derived from overlapping clinical variables recorded at time of evaluation, including age, vital signs, comorbidities, and biomarkers.…”

Section: Resultsmentioning

confidence: 99%

Midregional Proadrenomedullin Predicts Mortality and Major Adverse Cardiac Events in Patients Presenting With Chest Pain: Results From the CHOPIN Trial

Shah

Marston

Müeller

et al. 2015

Academic Emergency Medicine

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Objectives: Chest pain is a common complaint to emergency departments (EDs) and clinical risk factors are used to predict which patients are at risk for worse outcomes and mortality. The goal was to assess the novel biomarker midregional proadrenomedullin (MR-proADM) in prediction of mortality and major adverse cardiac events (MACE).Methods: This was a subanalysis of the CHOPIN study, a 16-center prospective trial that enrolled 2,071 patients presenting with chest pain within 6 hours of onset. The primary endpoint was 6-month all-cause mortality and the secondary endpoint was 30-day and 6-month MACE: ED visits or hospitalization for acute myocardial infarction, unstable angina, reinfarction, revascularization, and heart failure.Results: MR-proADM performed similarly to troponin (cTnI; c-statistic = 0.845 and 0.794, respectively) for mortality prediction in all subjects and had similar results in those with noncardiac diagnoses. MRproADM concentrations were stratified by decile, and the cohort in the top decile had a 9.8% 6-month mortality risk versus 0.9% risk for those in the bottom nine deciles (p < 0.0001). MR-proADM, history of coronary artery disease (CAD), and hypertension were predictors of short-term MACE, while history of CAD, hypertension, cTnI, and MR-proADM were predictors of long-term MACE.

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“…We intend to follow up with a prospective observational study, likely modifying the new VCP Rule and comparing with other possible clinical rules. 33,34 This could be in combination with pointof-care testing. However, these rules may have more utility when combined with clinical pretest probabilities as indicated by our study.…”

Section: Discussionmentioning

confidence: 99%

Validation of the new Vancouver Chest Pain Rule in Asian chest pain patients presenting at the emergency department

Ong

Ying

Yap

et al. 2016

CJEM

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Objectives: The new Vancouver Chest Pain (VCP) Rule recommends early discharge for chest pain patients who are at low risk of developing acute coronary syndrome (ACS), and thus can be discharged within 2 hours of arrival at the emergency department (ED). This study aimed to assess the performance of the new VCP Rule for Asian patients presenting with chest pain at the ED. Methods: This prospective cohort study involved patients attended to at the ED of a large urban centre. Patients of at least 25 years old, presenting with stable chest pain and a non-diagnostic ECG, and with no history of active coronary artery disease were included in the study. The main outcome measures were cardiac events, angioplasty, or coronary artery bypass within 30 days of enrolment. Results: The study included 1690 patients from 27 August 2000 to 1 May 2002, with 661 patients fulfilling the VCP criteria. Of those for early discharge, 24 had cardiac events and 13 had angioplasty or bypass at 30 days, compared to 91 and 41, respectively, for those unsuitable for discharge. This gave the rule a sensitivity of 78.1% for cardiac events, including angioplasty and bypass. Specificity was 41.0%, and negative predictive value (NPV) was 94.4%. Conclusion: We found the new VCP Rule to have moderate sensitivity and poor specificity for adverse cardiac events in our population. With an NPV of less than 100%, this means that a small proportion of patients sent home with early discharge would still have adverse cardiac events. RÉSUMÉObjectifs: Selon la nouvelle règle de Vancouver sur la douleur thoracique, il est recommandé que les patients qui présentent des douleurs thoraciques mais qui connaissent un faible risque de syndrome coronarien aigu puissent être renvoyés peu de temps après leur arrivée au service des urgences (SU), soit dans les deux heures suivantes. L'étude visait à évaluer la performance de la nouvelle règle de Vancouver chez des patients d'origine asiatique présentant des douleurs thoraciques, au SU. Méthode: Il s'agit d'une étude de cohorte, prospective, à laquelle ont participé des patients traités dans un SU d'un important centre urbain. Ont été sélectionnés des patients âgés d'au moins 25 ans, qui présentaient une douleur thoracique stable mais chez qui l'ECG s'est révélé non concluant et qui n'avaient pas d'antécédents de coronaropathie active. Les principaux critères d'évaluation consistaient en la survenue d'événements cardiaques ou encore en la réalisation d'une angioplastie ou d'un pontage coronarien dans les 30 jours suivant l'inclusion dans l'étude. Résultats: Au total, 1690 patients ont participé à l'étude, du 27 août 2000 au 1 er mai 2002, dont 661 répondaient aux critères de la nouvelle règle de Vancouver. Parmi ceux qui ont été renvoyés peu de temps après leur arrivée, 24 ont subi un événement cardiaque et 13 autres, une angioplastie ou un pontage coronarien au bout de 30 jours contre 91 et 41 respectivement parmi ceux qui n'étaient pas en état de quitter l'hôpital. Ainsi, la sensibilité de la règle s'est étab...

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A prospective validation of the HEART score for chest pain patients at the emergency department

Cited by 445 publications

References 33 publications

Evaluation Efficacy of HEART Score in Prediction of Major Advanced Cardiac Events in Patients with Chest Pain

Evaluation Efficacy of HEART Score in Prediction of Major Advanced Cardiac Events in Patients with Chest Pain

Midregional Proadrenomedullin Predicts Mortality and Major Adverse Cardiac Events in Patients Presenting With Chest Pain: Results From the CHOPIN Trial

Validation of the new Vancouver Chest Pain Rule in Asian chest pain patients presenting at the emergency department

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