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

The authors reviewed articles published between March 2018-April 2019 for the Hospital Medicine Updates at the Society of Hospital Medicine and the Society of General Internal Medicine Annual Meetings. The authors voted to select 10 of 30 presented articles based on quality and clinical impact for this summary. The key findings include: (1) Vancomycin or fidaxomicin are the first-line treatment for initial Clostridioides difficile infection; (2) Unnecessary supplemental oxygen is linked to increased mortality; aim for a target oxygen saturation of 90%-94% in most hospitalized patients; (3) Stigmatizing language in medical records impacts physician trainees’ attitudes and pain management practices; (4) Consider ablation for atrial fibrillation in patients with heart failure; (5) Patients with opioid use disorder should be offered buprenorphine or methadone therapy; (6) Apixaban is safe and may be preferable over warfarin in patients with atrial fibrillation and end-stage kidney disease; (7) It is probably safe to discontinue antimethicillin-resistant Staphylococcus aureus (MRSA) coverage in patients with hospital-acquired pneumonia who are improving and have negative cultures; (8) Selected patients with left-sided endocarditis (excluding MRSA) may switch from intravenous (IV) to oral antibiotics if they are clinically stable after 10 days; (9) Oral antibiotics may be equivalent to IV antibiotics in patients with joint and soft tissue infections; (10) A history–electrocardiogram–age–risk factors–troponin (HEART) score ≥4 is a reliable threshold for determining the patients who are at risk for short-term major adverse cardiac events and may warrant further evaluation.

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“…2019;26(2):140-151. 13 Background. Chest pain accounts for over eight million emergency department (ED) visits yearly in the United States.…”

Section: Medication For Opioid Usementioning

confidence: 99%

Hospital Medicine Update: High-Impact Literature from March 2018 to April 2019

Donovan¹,

Burger²,

Moriates³

et al. 2019

J Hosp Med

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“…Several established clinical scores have been used for risk stratifying chest pain patients in the ED [4,5], including the History, ECG, Age, Risk factors and Troponin (HEART) [6], the Thrombolysis in Myocardial Infarction (TIMI) [7], and the Global Registry of Acute Coronary Events (GRACE) [8] scores. Of these scores, the HEART score is the most accurate and widely used [5,[9][10][11][12], with recent studies focusing on the development of risk score-based clinical pathways for rapid, yet safe discharge of low-risk patients [1,3,13,14].…”

Section: Introductionmentioning

confidence: 99%

Heart rate n-variability (HRnV) and its application to risk stratification of chest pain patients in the emergency department

Liu

Guo

Koh

et al. 2020

BMC Cardiovasc Disord

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Background: Chest pain is one of the most common complaints among patients presenting to the emergency department (ED). Causes of chest pain can be benign or life threatening, making accurate risk stratification a critical issue in the ED. In addition to the use of established clinical scores, prior studies have attempted to create predictive models with heart rate variability (HRV). In this study, we proposed heart rate n-variability (HRnV), an alternative representation of beat-to-beat variation in electrocardiogram (ECG), and investigated its association with major adverse cardiac events (MACE) in ED patients with chest pain. Methods: We conducted a retrospective analysis of data collected from the ED of a tertiary hospital in Singapore between September 2010 and July 2015. Patients > 20 years old who presented to the ED with chief complaint of chest pain were conveniently recruited. Five to six-minute single-lead ECGs, demographics, medical history, troponin, and other required variables were collected. We developed the HRnV-Calc software to calculate HRnV parameters. The primary outcome was 30-day MACE, which included all-cause death, acute myocardial infarction, and revascularization. Univariable and multivariable logistic regression analyses were conducted to investigate the association between individual risk factors and the outcome. Receiver operating characteristic (ROC) analysis was performed to compare the HRnV model (based on leave-one-out cross-validation) against other clinical scores in predicting 30-day MACE.

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“…In a recent issue, Fernando et al . present a systematic review and meta‐analysis assessing the prognostic accuracy of the HEART score for prediction of major adverse cardiac events (MACE) in adult patients presenting with chest pain at the emergency department (ED).…”

mentioning

confidence: 99%