Prehospital Modified HEART Score Predictive of 30-Day Adverse Cardiac Events

Abstract

Prehospital modified HEART scores have a high NPV for MACE at 30 days. A study in which prehospital providers prospectively apply this decision aid is warranted. Stopyra JP , Harper WS , Higgins TJ , Prokesova JV , Winslow JE , Nelson RD , Alson RL , Davis CA , Russell GB , Miller CD , Mahler SA . Prehospital modified HEART score predictive of 30-day adverse cardiac events. Prehosp Disaster Med. 2018;33(1):58-62.

Role of Biomarkers in the Prediction of Serious Adverse Events after Syncope in Prehospital Assessment: A Multi-Center Observational Study

“…Our results are in line with studies that have analyzed prognostic scores and mortality data for syncope patients [24][25][26][27][28], although those had been conducted in the ED. Other work has analyzed the combined use of EWSs and lactate in other contexts [29][30][31][32] and also obtained areas under the ROC curve between 0.830 and 0.914 for detecting two-day mortality.…”

“…Current guidelines for the management of syncope emphasize the initial clinical and physical evaluation, as well as the early performance of an electrocardiogram and analytical tests, with the fundamental objective of not underestimating potentially risky syncope situations [1,4,33,34]. The new score, NEWS2-L, is in line with the decision rules implemented in the current guidelines, with a high specificity (81.2%; 95% CI 76.7-85.0), higher than other risk stratification scores, such as the FAINT score [35] (22.2%; 95% CI 20.7-23.8), HEART score [26] (36.5%; 95% CI 33.0-40.2), or the OESIL score [36] (73.0%; 95% CI 0.66-0.74). This makes this score an ideal tool for the detection of syncopal episodes that could initially be classified as mild but that actually present a high risk of deterioration.…”

“…Due to the ease of application and interpretation of the NEWS2-L, this score is ideal for use by nonexpert health personnel and can help discriminate the severity of the condition in different contexts very early. Therefore, it could be an advantage to not include electrocardiogram interpretation, more specific analytical tests or the presence of guiding symptoms, as in the FAINT score (history of heart failure, history of cardiac arrhythmia, initial abnormal ECG result, elevated pro B-type natriuretic peptide, and elevated high-sensitivity troponin T) [35], HEART (history, ECG, age, risk factors, and troponin) [26], OESIL score (abnormal ECG, age >65 years, history of cardiovascular disease) [39].…”

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

“…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).…”

“…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 .…”