HEART score and clinical gestalt have similar diagnostic accuracy for diagnosing ACS in an unselected population of patients with chest pain presenting in the ED

Visser, Anita; Wolthuis, Albert; Breedveld, R.; Avest, Ewoud ter

doi:10.1136/emermed-2014-203798

Cited by 54 publications

(47 citation statements)

References 27 publications

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“…Previous studies have demonstrated that clinician gestalt alone is insufficient or not superior for identifying patients who are safe to discharge from the ED . However, the unstructured assessment used in these studies is generally a scale or an impression code of ACS probability completed based on history, symptoms, and physical examination performed by physicians.…”

Section: Discussionmentioning

confidence: 99%

“…Only the change in cTn over time is considered. Therefore, it remains controversial whether simple, structured risk tools can surpass real, complex judgments …”

Section: Introductionmentioning

confidence: 99%

“…Therefore, it remains controversial whether simple, structured risk tools can surpass real, complex judgments. 15,17,23 The performance of disposition decision protocols to discharge low-risk patients mainly depends on efficacy (defined as the proportion of patients discharged) and safety (quantified by the sensitivity and negative predictive value [NPV] for MACE). 24 In this study, we aimed to compare the efficacy and safety of usual care with the potentially used HEART score and pathway to identify patients for direct discharge in a tertiary hospital.…”

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confidence: 99%

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Comparison of usual care and the HEART score for effectively and safely discharging patients with low‐risk chest pain in the emergency department: would the score always help?

Wang

Zheng

et al. 2019

Clinical Cardiology

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Background Triage decisions for chest pain patients receiving usual care are based on a dynamic and comprehensive strategy performed in the physician's mind. It remains controversial whether simple, structured risk tools can surpass real, complex judgments. Hypothesis The potentially used History, Electrocardiogram, Age, Risk factors, Troponin (HEART) score would help identify low‐risk patients for discharge. Methods Patients with acute, non‐traumatic chest pain managed according to usual care were consecutively enrolled in a tertiary university hospital in China from August 24, 2015 to September 30, 2017. Major adverse cardiac events (MACE) included death, acute myocardial infarction, revascularization, and significant coronary stenosis (>50%) within 30 days. We compared the efficacy and safety of usual care and the potentially used HEART score in this population. Results Of 2185 patients analyzed, 926 (42.4%) patients were directly discharged by usual care, whereas HEART≤3 would have identified 524 (24.0%) patients as low‐risk (P < .001). The MACE rate in discharged patients was 2.2% (20/926) and would have been 5.2% (27/524) in those with HEART≤3 (P = .002). For discharged patients, the MACE rates in HEART≤3 vs HEART>3 groups were not significantly different (1.5% vs 2.7%, P = .225). Negative predictive value (NPV) was higher with usual care than with the HEART score (P = .003), but sensitivity was similar. For 340 patients with serial troponins, usual care was superior to the potentially used HEART score in regard to efficacy. Conclusions At this institution, usual care identified many more patients for discharge than the HEART score would have without apparently different outcomes in discharged patients with lower vs higher HEART scores. The HEART score would not appear to provide helpful risk stratification.

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Section: Discussionmentioning

confidence: 99%

“…Only the change in cTn over time is considered. Therefore, it remains controversial whether simple, structured risk tools can surpass real, complex judgments …”

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Comparison of usual care and the HEART score for effectively and safely discharging patients with low‐risk chest pain in the emergency department: would the score always help?

Wang

Zheng

et al. 2019

Clinical Cardiology

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“…The primary end point of the HEART score is a composite of: acute myocardial infarction (AMI), percutaneous coronary intervention (PCI), coronary artery bypass graft (CABG)surgery and death, all occurring within 6 weeks, together called MACE. These outcomes are typically related to an ACS and therefore considered indirect proof of the diagnosis 8 .…”

Section: Introductionmentioning

confidence: 99%

“…The two most commonly used scores are the Global Registry in Acute Coronary Events 6 and the Thrombolysis in Myocardial Infarction (TIMI) 7,8 .…”

Section: Introductionmentioning

confidence: 99%

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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The predictive value of the HEART and GRACE scores for major adverse cardiac events in patients with acute chest pain

et al. 2020

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HEART score and clinical gestalt have similar diagnostic accuracy for diagnosing ACS in an unselected population of patients with chest pain presenting in the ED

Abstract: Our study demonstrates that HEART score and clinical gestalt have similar diagnostic accuracy for diagnosing ACS in an unselected population of patients with chest pain presenting in the ED.

Cited by 54 publications

References 27 publications

Comparison of usual care and the HEART score for effectively and safely discharging patients with low‐risk chest pain in the emergency department: would the score always help?

Comparison of usual care and the HEART score for effectively and safely discharging patients with low‐risk chest pain in the emergency department: would the score always help?

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

The predictive value of the HEART and GRACE scores for major adverse cardiac events in patients with acute chest pain

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