A Closer Look at the HEART Score

Aung, Sammy San Myint; Roongsritong, Chantwit

doi:10.14740/cr1432

Cited by 6 publications

(2 citation statements)

References 50 publications

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“…Patients with extremely high and extremely low 0 h hs-cTnT could gain an exact same HEART score. Meanwhile, with the introduction of more sensitive troponin assays, it is becoming more difficult for the HEART pathway to identify low-risk patients for early discharge [33]. Therefore, we believe that the HEAR pathway, which separates 0 h hs-cTnT measurement from initial clinical assessment, could have an advantage over the prior HEART pathway.…”

Section: Discussionmentioning

confidence: 99%

Derivation of a HEAR Pathway for Emergency Department Chest Pain Patients to Safely Avoid a Second Troponin Test

Chen,

Yu,

Chen

et al. 2023

Diagnostics

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The study aims to develop a decision pathway based on HEAR score and 0 h high-sensitivity cardiac troponin T (hs-cTnT) to safely avoid a second troponin test for suspected non-ST elevation myocardial infarction (NSTEMI) in emergency departments. A HEAR score consists of history, electrocardiogram, age, and risk factors. A HEAR pathway is established using a Bayesian approach based on a predefined safety threshold of NSTEMI prevalence in the rule-out group. In total, 7131 patients were retrospectively enrolled, 582 (8.2%) with index visit NSTEMI and 940 (13.2%) with 180-day major adverse cardiovascular events (MACE). For patients with a low-risk HEAR score (0 to 2) and low 0 h hs-cTnT (<14 ng/L), the HEAR pathway recommends early discharge without further testing. After the HEAR pathway had been applied to rule out NSTEMI, the negative predictive value of index visit NSTEMI was 100.0% (95% CI, 99.8% to 100.0%) and false-negative rate of 180-day MACE was 0.40% (95% CI, 0.18% to 0.87%). Compared with the 0 h hs-cTnT < limit of detection (LoD) strategy (<5 ng/L), the HEAR pathway could correctly reclassify 1298 patients without MACE as low risk and lead to a 18.2% decrease (95% CI, 17.4–19.1%) in the need for a second troponin test. The HEAR pathway may lead to a substantial and safe reduction in repeated troponin test for emergency department patients with suspected NSTEMI.

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Section: Discussionmentioning

confidence: 99%

Derivation of a HEAR Pathway for Emergency Department Chest Pain Patients to Safely Avoid a Second Troponin Test

Chen,

Yu,

Chen

et al. 2023

Diagnostics

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“…For adults, there are several scoring systems to predict major adverse cardiac events (MACE) in patients with acute chest pain, such as the thrombolysis in myocardial infarction (TIMI) risk score, the global registry of acute coronary events (GARCE) score, and the HEART score. These scoring systems are widely used in emergency departments, and each of them revealed different sensitivity and specificity to MACE [ 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ]. In pediatric patients, a scoring system is not well-established.…”

Section: Introductionmentioning

confidence: 99%

Pediatric Chest Pain: A Review of Diagnostic Tools in the Pediatric Emergency Department

Huang,

Liu

2024

Diagnostics

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Pediatric chest pain is a common chief complaint in the emergency department. Not surprisingly, children with chest pain are usually brought to the emergency department by their parents out of fear of heart disease. However, chest pain in the pediatric population is generally a benign disease. In this review, we have identified musculoskeletal pain as the most prevalent etiology of chest pain in the pediatric population, accounting for 38.7–86.3% of cases, followed by pulmonary (1.8–12.8%), gastrointestinal (0.3–9.3%), psychogenic (5.1–83.6%), and cardiac chest pain (0.3–8.0%). Various diagnostic procedures are commonly used in the emergency department for cardiac chest pain, including electrocardiogram (ECG), chest radiography, cardiac troponin examination, and echocardiography. However, these examinations demonstrate limited sensitivity in identifying cardiac etiologies, with sensitivities ranging from 0 to 17.8% for ECG and 11.0 to 17.2% for chest radiography. To avoid the overuse of these diagnostic tools, a well-designed standardized algorithm for pediatric chest pain could decrease unnecessary examination without missing severe diseases.

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