A prospective validation of the HEART score for chest pain patients at the emergency department

• Published in: International journal of cardiology Vol. 168; no. 3; pp. 2153 - 2158
• Main Authors: Backus, B.E, Six, A.J, Kelder, J.C, Bosschaert, M.A.R, Mast, E.G, Mosterd, A, Veldkamp, R.F, Wardeh, A.J, Tio, R, Braam, R, Monnink, S.H.J, van Tooren, R, Mast, T.P, van den Akker, F, Cramer, M.J.M, Poldervaart, J.M, Hoes, A.W, Doevendans, P.A
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier Ireland Ltd 03.10.2013; Elsevier
• Subjects: Acute coronary syndrome; Aged; Biological and medical sciences; Cardiology. Vascular system; Cardiovascular; Chest pain; Chest Pain - diagnosis; Chest Pain - epidemiology; Chest Pain - etiology; Coronary Angiography - methods; Coronary heart disease; Diagnosis, Differential; Electrocardiography; Emergency room; Emergency Service, Hospital; Female; Follow-Up Studies; Heart; HEART score; Humans; Male; Medical sciences; Middle Aged; Myocardial Infarction - complications; Myocardial Infarction - diagnosis; Myocardial Infarction - epidemiology; Myocarditis. Cardiomyopathies; Netherlands - epidemiology; Prospective Studies; Risk Assessment - methods; Risk Factors; Risk score; Severity of Illness Index; Survival Rate - trends; Netherlands; HEART score; Risk score; Emergency room; Acute coronary syndrome; Chest pain; Heart; Human; Patient; Cardiovascular disease; Risk; Thorax; Coronary heart disease; Myocardial disease; Prospective; Test validation; Pain; Emergency department; Risk factor; Circulatory system; Emergency; Cardiology
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2013.01.255

Abstract Background 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). The HEART score was designed to facilitate this process. This study is a prospective validation of the HEART score. Methods A total of 2440 unselected patients presented with chest pain at the cardiac emergency department of ten participating hospitals in The Netherlands. The HEART score was assessed as soon as the first lab results and ECG were obtained. Primary endpoint was the occurrence of major adverse cardiac events (MACE) within 6 weeks. Secondary endpoints were (i) the occurrence of AMI and death, (ii) ACS and (iii) the performance of a coronary angiogram. The performance of the HEART score was compared with the TIMI and GRACE scores. Results Low HEART scores (values 0–3) were calculated in 36.4% of the patients. MACE occurred in 1.7%. In patients with HEART scores 4–6, MACE was diagnosed in 16.6%. In patients with high HEART scores (values 7–10), MACE occurred in 50.1%. The c-statistic of the HEART score (0.83) is significantly higher than the c-statistic of TIMI (0.75)and GRACE (0.70) respectively (p < 0.0001). Conclusion The HEART score provides the clinician with a quick and reliable predictor of outcome, without computer-required calculating. Low HEART scores (0–3), exclude short-term MACE with > 98% certainty. In these patients one might consider reserved policies. In patients with high HEART scores (7–10) the high risk of MACE may indicate more aggressive policies.