Applying the HEART score is safe and saves

Abstract

Koper et al. performed an encouraging study (Urgent 1.5) to fine-tune the well-established HEART score [1], which was previously initiated and validated by the cardiologist Jacob Six. He and several PhD students looked at various aspects of the score, which was based on clinical intuition and experience to rule out an acute coronary syndrome (ACS). However, not every parameter (history, electrocardiogram [ECG], age, risk factor and troponin) or value (0, 1, 2) used to generate the score was validated initially. Yet the score outperformed all competitors, also because of patient selection. Interesting was the finding that calculation of the C-statistic to determine the weight of the 5 items times 3 values provided a 99% match [2]. The score was designed to rule out serious ACS in chest pain patients, who are swamping healthcare facilities. Therefore we focus on the low-risk group (HEART score 0-3) visiting the emergency department (ED) with potentially the largest gain for both patients and physicians. Even in low-risk patients many expensive diagnostic tests are performed which are time consuming and put the patient at risk during invasive procedures [3]. Even in the small study reported by Koper et al. [1], in patients with a low-risk score a very high sensitivity (97%) and negative predictive value (97.6%) are reported using the modified HEART score, and only one ACS was missed. Importantly, the study included a point-of-care (POC)-based test assessed by