The HEART Score for the Assessment of Patients With Chest Pain in the Emergency Department
Top Cited Papers
- 1 September 2013
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine
- Vol. 12 (3), 121-126
- https://doi.org/10.1097/hpc.0b013e31828b327e
Abstract
The HEART score for the early risk stratification of patients presenting to the emergency department with chest pain contains 5 elements: history, electrocardiogram, age, risk factors, and troponin. It has been validated in The Netherlands. The purpose of this investigation was to perform an external validation of the HEART score in an Asia-Pacific population. Data were used from 2906 patients presenting with chest pain to the emergency departments of 14 hospitals. HEART scores were determined retrospectively. Three risk groups were composed based on previous research. The predictive values for the occurrence of 30-day major adverse coronary events (MACE) were assessed. A comparison was made with the Thrombolysis in Myocardial Infarction (TIMI) score in terms of the value of C-statistics. The low-risk group, HEART score ≤ 3, consisted of 820/2906 patients (28.2%). Fourteen (1.7%) patients were incorrectly defined as low risk (false negatives). The high-risk population, HEART score 7-10, consisted of 464 patients (16%) with a risk of MACE of 43.1%. The C-statistics were 0.83 (0.81-0.85) for HEART and 0.75 (0.72-0.77) for TIMI (P < 0.01). Utilization of the HEART score provided excellent determination of risk for 30-day MACE, comparing well with the Thrombolysis in Myocardial Infarction score. This study externally validates previous findings that HEART is a powerful clinical tool in this setting. It quickly identifies both a large proportion of low-risk patients, in whom early discharge without additional testing goes with a risk of MACE of only 1.7%, and high-risk patients who are potential candidates for early invasive strategies.Keywords
This publication has 14 references indexed in Scilit:
- Comparison of Cardiac Risk Scores in ED Patients With Potential Acute Coronary SyndromeCritical Pathways in Cardiology: A Journal of Evidence-Based Medicine, 2011
- Combining Thrombolysis in Myocardial Infarction risk score and clear-cut alternative diagnosis for chest pain risk stratificationThe American Journal of Emergency Medicine, 2009
- Universal Definition of Myocardial InfarctionCirculation, 2007
- Guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes: The Task Force for the Diagnosis and Treatment of Non-ST-Segment Elevation Acute Coronary Syndromes of the European Society of CardiologyEuropean Heart Journal, 2007
- Impact of anaemia, bleeding, and transfusions in acute coronary syndromes: a shift in the paradigmEuropean Heart Journal, 2007
- Risk prediction in patients presenting with suspected cardiac pain: the GRACE and TIMI risk scores versus clinical evaluationQJM: An International Journal of Medicine, 2006
- Prospective Validation of the Thrombolysis in Myocardial Infarction Risk Score in the Emergency Department Chest Pain PopulationAnnals of Emergency Medicine, 2006
- Application of the TIMI Risk Score for Unstable Angina and Non-ST Elevation Acute Coronary Syndrome to an Unselected Emergency Department Chest Pain PopulationAcademic Emergency Medicine, 2006
- Application of the TIMI Risk Score for Unstable Angina and Non‐ST Elevation Acute Coronary Syndrome to an Unselected Emergency Department Chest Pain PopulationAcademic Emergency Medicine, 2006
- Missed Diagnoses of Acute Cardiac Ischemia in the Emergency DepartmentThe New England Journal of Medicine, 2000