The HEART Score for Suspected Acute Coronary Syndrome in U.S. Emergency Departments

Sharp, Adam L.; Wu, Yi; Shen, Ernest; Redberg, Rita F.; Lee, Ming Sum; Ferencik, Maros; Natsui, Shaw; Zheng, Chengyi; Kawatkar, Aniket A.; Gould, Michael K.; Sun, Benjamin

doi:10.1016/j.jacc.2018.07.059

Cited by 31 publications

(24 citation statements)

References 5 publications

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“…Acute coronary syndrome (ACS) continues to be the leading cause of morbidity and mortality worldwide, costing billions of dollars in medical costs and depleting many public health resources [1]. However, the mechanisms underlying the poor prognosis of ACS patients have not yet been well elucidated, and it may be affected by several factors, such as baseline characteristics and treatment before, during, and after hospitalization [2].…”

Section: Introductionmentioning

confidence: 99%

Usefulness of Serum Calcium in the Risk Stratification of Midterm Mortality among Patients with Acute Coronary Syndrome

Ding

Sun

et al. 2019

BioMed Research International

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Serum calcium has been reported to be a predictor of short-term prognosis; however, evidence regarding its association with midterm mortality is scarce. We investigated the association between serum calcium levels at admission and midterm mortality in a retrospective cohort of 2594 consecutive patients with acute coronary syndrome (ACS) who presented to the First Affiliated Hospital of Harbin Medical University from November 2014 to December 2016. Patients were assigned to 4 groups according to the quartiles of serum calcium levels (Ca-Q1–4) and were followed longitudinally for the time to all-cause death. During a median follow-up period of 21.8 months (17.5∼29.5, IQR), 124 patients died (4.8%) of all causes. Kaplan–Meier curves showed that the incidence of midterm mortality differed significantly (log-rank P=0.038) among the quartiles of serum calcium levels at admission. After adjustment for the confounders that were significant in the univariate analysis, the hazard ratios for the lowest quartile of serum calcium was 1.86 (95% CI, 1.05–3.31; P=0.033), compared with the third quartile (reference group). A multiple restricted cubic spline regression model suggested a reverse J-shaped association between serum calcium levels and midterm mortality, and the lowest risk of mortality was associated with approximately 2.32 mmol/l of serum calcium. In conclusion, the serum calcium level is an independent predictor of all-cause midterm mortality among ACS patients. Patients with abnormal serum calcium levels at admission need more targeted treatments.

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Section: Introductionmentioning

confidence: 99%

Usefulness of Serum Calcium in the Risk Stratification of Midterm Mortality among Patients with Acute Coronary Syndrome

Ding

Sun

et al. 2019

BioMed Research International

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“…Noninvasive cardiac testing was defined as either an ED referral to a cardiology department for a noninvasive stress test or an order prompting a clinical procedural terminology code during the ED encounter (Data Supplement ). Current evidence and KPSC recommendations indicate that low‐risk patient encounters should avoid hospital admission or further cardiac testing …”

Section: Methodsmentioning

confidence: 99%

“…Many health systems have undertaken efforts to improve patient care by implementing risk stratification tools, specifically HEART . Kaiser Permanente Southern California (KPSC) adopted a HEART clinical reference for emergency physicians in 2016 and details regarding these recommendations and the results have been previously published …”

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confidence: 99%

Impact of Physician–Patient Language Concordance on Patient Outcomes and Adherence to Clinical Chest Pain Recommendations

Altman

Sun

Lin

et al. 2020

Academic Emergency Medicine

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Objectives The objective was to evaluate if there is an association between patient–physician language concordance and adverse patient outcomes or physician adherence to clinical recommendations for emergency department (ED) patients with chest pain. Methods We conducted a retrospective observational study of adult ED chest pain encounters with a troponin order from May 2016 to September 2017 across 15 community EDs. Outcomes were 30‐day acute myocardial infarction or all‐cause mortality, hospital admission/observation, or noninvasive cardiac testing. To assess patient outcomes, we used the overall cohort. To assess adherence to clinical recommendations, we used a subgroup of patients with a low‐risk HEART score. A mixed‐effects logistic regression model was used to compare the odds of the outcomes between language concordant and discordant patient–physician pairs, controlling for patient characteristics. Results Overall, 52,014 ED encounters were included (10,791 low‐risk HEART encounters). Of those 6,452 (12.4%) encounters were language discordant and 1.7% in each group had an adverse outcome. Adjusted models demonstrated no increased risk for language discordant ED encounters when comparing adverse outcomes (odds ratio [OR] = 0.96, 95% confidence interval [CI] = 0.6 to 1.5) for all patients or recommended care (OR = 1.02, 95% CI = 0.87 to 1.2) for low‐risk patients. Conclusions No associations were found between patient–physician language concordance and outcomes or physician adherence to clinical recommendations for ED patients with chest pain. Accessible and effective interpretation services, combined with a decision support tool with standard clinical recommendations, may have contributed to equitable care.

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“…3 Prior reports have demonstrated rates of 30-day death or acute myocardial infarction for patients evaluated in community EDs in the United States (US) to be below 1% for patients with HEART scores ≤5. 4…”

Section: Introductionmentioning

confidence: 99%

“…The 5‐component HEART score (H = history, E = electrocardiogram [ECG], A = age, R = risk factors, T = troponin, with each component graded from 0 to 2, for a total between 0 and 10) is recommended in American Heart Association guidelines to help risk stratify patients and is being increasingly used to assist in the evaluation of patients with suspected acute coronary syndrome 3 . Prior reports have demonstrated rates of 30‐day death or acute myocardial infarction for patients evaluated in community EDs in the United States (US) to be below 1% for patients with HEART scores ≤5 4 …”

Section: Introductionmentioning

confidence: 99%

Not all HEART scores are created equal: identifying “low‐risk” patients at higher risk

et al. 2020

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Objective: We sought to identify subgroups of "low-risk" HEART score patients (history, ECG, age, risk factors, and troponin) at elevated risk of acute myocardial infarction or death within 30 days. Methods: We performed a secondary analysis of prospective emergency department (ED) encounters for suspected acute coronary syndrome in a large health system with low-risk HEART scores (0-5 points). Logistic regression using the 5 components of the HEART score analyzed the increase risk attributable to points from each of the 5 score components. Results: Of 30,971 encounters among 28,992 unique patients, 135 (0.44%, 95% confidence interval [CI] = 0.37-0.51) experienced acute myocardial infarction or death.

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The HEART Score for Suspected Acute Coronary Syndrome in U.S. Emergency Departments

Cited by 31 publications

References 5 publications

Usefulness of Serum Calcium in the Risk Stratification of Midterm Mortality among Patients with Acute Coronary Syndrome

Usefulness of Serum Calcium in the Risk Stratification of Midterm Mortality among Patients with Acute Coronary Syndrome

Impact of Physician–Patient Language Concordance on Patient Outcomes and Adherence to Clinical Chest Pain Recommendations

Not all HEART scores are created equal: identifying “low‐risk” patients at higher risk

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