Clinical utility of the HEART score in patients admitted with chest pain to an inner-city hospital in the USA

Patnaik, Soumya; Shah, Mahek; Alhamshari, Yaser; Ram, Pradhum; Puri, Ritika; Lu, Marvin; Balderia, Percy; Imms, John B.; Maludum, Obiora; Figueredo, Vincent M.

doi:10.1097/mca.0000000000000474

Cited by 15 publications

(9 citation statements)

References 12 publications

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“…Our search identified 778 citations (Figure ) and following removal of duplicates, we screened 557 studies, from which 62 studies underwent full‐text review. We included 29 distinct cohorts from 30 studies in the meta‐analysis . All included studies evaluated the prognostic accuracy of the HEART score using a low‐risk threshold (score between 0 and 3).…”

Section: Resultsmentioning

confidence: 99%

“…There were 17 (56.7%) retrospective cohorts, 11 (36.7%) prospective cohorts, and two (6.7%) randomized trials. Sixteen studies evaluated the HEART score for 30‐day incidence of MACE, while 13 evaluated the HEART score for 6‐week incidence of MACE . Most studies included only patients presenting with chest pain, while five studies included patients presenting with “suspected ACS.” In 14 studies, the ECG was interpreted by an ED physician, while in seven studies the ECG was specifically interpreted by a cardiologist .…”

Section: Resultsmentioning

confidence: 99%

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Prognostic Accuracy of the HEART Score for Prediction of Major Adverse Cardiac Events in Patients Presenting With Chest Pain: A Systematic Review and Meta‐analysis

Fernando

Tran

Cheng

et al. 2018

Academic Emergency Medicine

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Objective: The HEART score has been proposed for emergency department (ED) prediction of major adverse cardiac events (MACE). We sought to summarize all studies assessing the prognostic accuracy of the HEART score for prediction of MACE in adult ED patients presenting with chest pain.Methods: We searched MEDLINE, PubMed, EMBASE, Scopus, Web of Science, and the Cochrane Database of Systematic Reviews from inception through May 2018 and included studies using the HEART score for the prediction of short-term MACE in adult patients presenting to the ED with chest pain. The main outcome was short-term (i.e., 30-day or 6-week) incidence of MACE. We secondarily evaluated the prognostic accuracy of the HEART score for prediction of mortality and myocardial infarction (MI). Where available, accuracy of the Thrombolysis in Myocardial Infarction (TIMI) score was determined. Results:We included 30 studies (n = 44,202) in analysis. A HEART score above the low-risk threshold (≥4) had a sensitivity of 95.9% (95% confidence interval [CI] = 93.3%-97.5%) and specificity of 44.6% (95% CI = 38.8%-50.5%) for MACE. A high-risk HEART score (≥7) had a sensitivity of 39.5% (95% CI = 31.6%-48.1%) and specificity of 95.0% (95% CI = 92.6%-96.6%) for MACE, whereas a TIMI score above the low-risk threshold (≥2) had a sensitivity of 87.8% (95% CI = 80.2%-92.8%) and specificity of 48.1% (95% CI = 38.9%-57.5%) for MACE. A high-risk TIMI score (≥6) was 2.8% sensitive (95% CI = 0.8%-9.6%), but 99.6% (95% CI = 98.5%-99.9%) specific for MACE. A HEART score ≥ 4 had a sensitivity of 95.0% (95% CI = 87.2%-98.2%) for prediction of mortality and 97.5% (95% CI = 93.7%-99.0%) for prediction of MI.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Prognostic Accuracy of the HEART Score for Prediction of Major Adverse Cardiac Events in Patients Presenting With Chest Pain: A Systematic Review and Meta‐analysis

Fernando

Tran

Cheng

et al. 2018

Academic Emergency Medicine

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“…Since the inception of the HEART score, it has been validated in many trials, both retrospective and prospective. 4 , 5 , 6 , 9 , 10 , 11 , 12 , 9 , 10 , 11 , 12 Yet some clinicians are hesitant to discharge low-risk patients without further testing, prolonged observation, and/or hospital admission. 13 A common criticism was the use of a single troponin determination rather than serial testing.…”

Section: Development Of the Heart Pathwaymentioning

confidence: 99%

The HEART score: A guide to its application in the emergency department

Brady

Souza

2018

Turkish Journal of Emergency Medicine

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Chest pain is one of the most common, potentially serious presenting complaints for adult emergency department (ED) visits. The challenge of acute coronary syndrome (ACS) identification with appropriate disposition is quite significant. Many of these patients are low risk and can be managed non-urgently in the outpatient environment; other patients, however, are intermediate to high risk for ACS and should be managed more aggressively, likely with inpatient admission and cardiology consultation. The HEART score, a recently derived clinical decision rule aimed at the identification of risk in the undifferentiated chest pain patient, is potentially quite useful as an adjunct to physician medical decision-making. The HEART score identifies patients at low, intermediate, and high risk for short-term adverse outcome resulting from ACS. As is true of all such clinical decision rules, the physician should consider the information provided the HEART score yet exercise clinical judgment in the ultimate determination of management strategy in the adult chest pain patient suspected of ACS.

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“…However, low-risk patients have low-risk rates for MACE, and the performance of serial cardiac biomarker testing or stress testing in all lowrisk patients remains controversial. Moreover, referring lowrisk patients to a cardiologist and hospitalization may lead to dissatisfaction, overtreatment, and additional expenditure [9]. Nevertheless, high-risk patients who have been misdiagnosed as low-risk patients may progress to MI and could be victims of out-of-hospital sudden cardiac death.…”

Section: Discussionmentioning

confidence: 99%

Determining whether A Low HEART Score Is Associated with Low Risk in Coronary Angiography Results: Validation of HEART Score Using Coronary Angiography Results

Park¹,

Yoon²,

Jun³

et al. 2020

Signa Vitae

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Purpose: The history, electrocardiogram, age, risk factor, and troponin (HEART) score have not yet been adopted in the emergency department (ED) in South Korea. We aimed to investigate whether patients with low HEART scores have a low risk of coronary angiography (CAG) results. Methods: Patients with chest pain with a possible cardiac etiology in the ED were included. Patients were divided into low-risk (0 – 3), intermediate-risk (4 – 6), and high-risk (7 – 9) groups according to the HEART score. We analysed the CAG results of the included patients. CAG results were divided into four grades: Grade I, > 70%; Grade II, > 50%; Grade III, 10% – 50%; and Grade IV, < 10%of stenosis. The occurrence of a major adverse cardiac event (MACE) within 28 days was also investigated. Results: The study included 787 patients, of whom 458, 262, and 67 were included in the low-risk, intermediate-risk, and high-risk groups, respectively. A total of 118 cases of MACE occurred (average: 0.15 MACE/patient). MACE incidence was lower in the low-risk HEART score group than in the intermediate-risk and high-risk groups (0.4% vs. 22.1% and 86.6%, p < 0.001). The CAG results of the admitted patients with a low-risk HEART score were as follows: Grade I, 6.1%; Grade II, 3.0%; Grade III, 27.3%; and Grade IV, 63.6%. Conclusions: Patients with a low HEART score visiting the ED in Korea had a low risk in CAG results and a low probability of developing MACE. The successful utilization of the HEART score appears to be a rational approach that may avoid unnecessary testing in chest pain patients presenting to the ED.

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Clinical utility of the HEART score in patients admitted with chest pain to an inner-city hospital in the USA

Cited by 15 publications

References 12 publications

Prognostic Accuracy of the HEART Score for Prediction of Major Adverse Cardiac Events in Patients Presenting With Chest Pain: A Systematic Review and Meta‐analysis

Prognostic Accuracy of the HEART Score for Prediction of Major Adverse Cardiac Events in Patients Presenting With Chest Pain: A Systematic Review and Meta‐analysis

The HEART score: A guide to its application in the emergency department

Determining whether A Low HEART Score Is Associated with Low Risk in Coronary Angiography Results: Validation of HEART Score Using Coronary Angiography Results

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