Chest pain in the emergency room: value of the HEART score

Six, A. Jacob; Backus, Barbra E.; Kelder, Johannes C.

doi:10.1007/bf03086144

Cited by 531 publications

(626 citation statements)

References 11 publications

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“…Several risk scores have been developed, including Thrombolysis in Myocardial Infarction (TIMI); [4][5][6] Global Registry of Acute Coronary Events (GRACE); [7][8][9][10] Fast Revascularisation in Instability in Coronary disease (FRISC); 11 and History, ECG, Age, Risk factors, and Troponin (HEART), 12,13 to identify which patients with chest pain of cardiac etiology are at higher risk for worse cardiovascular outcomes and mortality. These scores are derived from overlapping clinical variables recorded at time of evaluation, including age, vital signs, comorbidities, and biomarkers.…”

Section: Discussionmentioning

confidence: 99%

Midregional Proadrenomedullin Predicts Mortality and Major Adverse Cardiac Events in Patients Presenting With Chest Pain: Results From the CHOPIN Trial

Shah

Marston

Müeller

et al. 2015

Academic Emergency Medicine

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Objectives: Chest pain is a common complaint to emergency departments (EDs) and clinical risk factors are used to predict which patients are at risk for worse outcomes and mortality. The goal was to assess the novel biomarker midregional proadrenomedullin (MR-proADM) in prediction of mortality and major adverse cardiac events (MACE).Methods: This was a subanalysis of the CHOPIN study, a 16-center prospective trial that enrolled 2,071 patients presenting with chest pain within 6 hours of onset. The primary endpoint was 6-month all-cause mortality and the secondary endpoint was 30-day and 6-month MACE: ED visits or hospitalization for acute myocardial infarction, unstable angina, reinfarction, revascularization, and heart failure.Results: MR-proADM performed similarly to troponin (cTnI; c-statistic = 0.845 and 0.794, respectively) for mortality prediction in all subjects and had similar results in those with noncardiac diagnoses. MRproADM concentrations were stratified by decile, and the cohort in the top decile had a 9.8% 6-month mortality risk versus 0.9% risk for those in the bottom nine deciles (p < 0.0001). MR-proADM, history of coronary artery disease (CAD), and hypertension were predictors of short-term MACE, while history of CAD, hypertension, cTnI, and MR-proADM were predictors of long-term MACE.

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Section: Discussionmentioning

confidence: 99%

Midregional Proadrenomedullin Predicts Mortality and Major Adverse Cardiac Events in Patients Presenting With Chest Pain: Results From the CHOPIN Trial

Shah

Marston

Müeller

et al. 2015

Academic Emergency Medicine

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“…The HEART score algorithm13 is depicted in Table 1. The HEART score was retrospectively determined based on patient data recorded at time of presentation to the ED.…”

Section: Methodsmentioning

confidence: 99%

“…Myocardial necrosis can often be confirmed or excluded within 1 to 3 hours,11, 12 but the interpretation of troponin levels depends on clinical context and repeated measurements. The HEART score13, 14 is a simple and effective clinical prediction rule incorporating both clinical context— H istory, E lectrocardiograph, A ge and R isk factors—and admission T roponin levels. Using solely information collected at time of presentation, the HEART score is able to accurately estimate a patient's short‐term cardiac risk, taking into account not only the risk of myocardial infarction during the index visit, but also major adverse cardiac events (MACE) that occur in the first 6 weeks thereafter.…”

Section: Introductionmentioning

confidence: 99%

Sex‐Based Differences in the Performance of the HEART Score in Patients Presenting to the Emergency Department With Acute Chest Pain

Bank

Hoog

Kleijn

et al. 2017

JAHA

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BackgroundSex‐based differences in clinical presentation, pathophysiology, and outcomes of patients with acute chest pain are increasingly being recognized, but are not implemented in guidelines and clinical prediction tools. We evaluated the performance of the HEART score in women versus men, because sex‐based differences may exist among the algorithm's components: history, electrocardiogram, age, risk factors, and admission troponin level.Methods and ResultsThe HEART score was retrospectively assessed in 831 women and 1084 men presenting to the emergency department with acute chest pain, assigning patients to the low‐, intermediate‐, or high‐risk category for the occurrence of major adverse cardiac events (MACE) within 6 weeks. MACE, consisting of myocardial infarction, coronary revascularization, and all‐cause death, also included events during index visit. Six‐week MACE rates were 2 times lower in women than men (10.0% versus 20.8%; P<0.01). Despite similar discriminatory accuracy of the HEART score among women and men (c‐statistic, 0.80 [0.75–0.84] versus 0.77 [0.74–0.81]; P=0.43), 6‐week MACE rates were significantly lower in women than men across all HEART risk categories: 2.1% versus 6.5% (P<0.01) in the low‐risk category, 12.7% versus 21.3% (P<0.01) in intermediate‐risk category, and 53.1% versus 77.0% (P=0.02) in the high‐risk category. The HEART score‐adjusted risk ratio for men was 1.6 (1.3–2.0; P<0.01).ConclusionsThe markedly higher 6‐week MACE risk in men across all HEART risk categories should be taken into account when using the HEART score to guide clinical decision making; early discharge with a low‐risk HEART score appears less safe for men than women with acute chest pain.

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“…in comparison to the other previous studies it can be concluded both HEART score of this study are higher than others. These factors had been estimated 6.51± 1.84 and 3.71 ± 1.83 [2], 7.2 ± 1.7 and 3.8 ± 1.9 [12], 6.54± 1.7 and 3.96 ±2 [13] (all of them P=0.001) respectively in other studies. It can be mentioned age (Mean[SD]) was 60.85±14.09, lower in our study compared with previous study 61.2 ±15.4 [2].…”

Section: Discussionmentioning

confidence: 89%

“…In certain cases, a diagnosis can be made quickly, in particular in the case of an acute transmural myocardial infarction. Non-ST-elevation ACS (nTEACS), previously called unstable angina or pending infarction, typically causes uncertain 1,2 . This diagnosis can be made quickly in case of concurrent typical changes in the electrocardiogram (ECG) and/or increased levels of myocardial markers in plasma.…”

Section: Introductionmentioning

confidence: 99%

Evaluation Efficacy of HEART Score in Prediction of Major Advanced Cardiac Events in Patients with Chest Pain

Bolvardi¹,

Raoufi²,

Vakili³

et al. 2016

Biosci., Biotech. Res. Asia

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Chest pain is one of the most common reasons for admitting patients to the emergency room. 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). Numerous risk prediction scores have been developed for fast and accurate risk stratification of chest pain in ED, like HEART score that a new ED Chest Pain risk stratification score. In this prospective cohort study, we aimed to evaluate efficacy of HEART score in prediction of 30 days major advanced cardiac events (MACE) in acute chest pain patients. A total of 100 unselected patients presented with acute chest pain at the cardiac emergency department of Emam Reza Hospital in Mashhad, from September 2015 until February 2016. The HEART score was assessed as soon as the first lab results and ECG were obtained. Endpoint was the occurrence of major adverse cardiac events (MACE) within 30 days. After 30-day follow-up, a total of 24 patients (24 %) reached one or more endpoints, AMI was diagnosed in 18 patients (18%), 2 patients (2%) underwent percutaneous coronary intervention (PCI), One (1%) had coronary artery bypass graft (CABG) surgery and 3 (3%) died. Independent predictors of MACE included age (P= 0.001). Hypertension was independent predictor of the combined end point only in female (P= 0.006). Age and troponin were independent predictors of the combined end point in both gender (Age P= 0.032 and Tpi P= 0.000). The average HEART score in the no end point group was 5.42 and in the patients with at least one end point was 7.42 (P=0.000). In low HEART scores (points 0-3), risk of MACE was 0%. In patients with HEART scores 4-6, MACE was diagnosed in 14.58%. In patients with high HEART scores (7-10), MACE occurred in 41.46%. In our study with increasing point of HEART score: sensitivity decreased, specifity increased and Positive predictive value increased.The HEART score helps in making accurate decisions at the emergency room without the use of invasive procedure. The HEART score is an easy, quick and reliable predictor of outcome in acute chest pain patients. It facilitates communication between doctors, especially when discussing the use of limited resources for chest pain patients. In this conditions who have higher HEART score points, choices may appear clear. This analysis suggests that HEART score can identify ED patients with acute chest pain for early discharge, as attention to high risk patients for admission for clinical observation, appropriate treatment including noninvasive testing and/or invasive strategies.

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Chest pain in the emergency room: value of the HEART score

Cited by 531 publications

References 11 publications

Midregional Proadrenomedullin Predicts Mortality and Major Adverse Cardiac Events in Patients Presenting With Chest Pain: Results From the CHOPIN Trial

Midregional Proadrenomedullin Predicts Mortality and Major Adverse Cardiac Events in Patients Presenting With Chest Pain: Results From the CHOPIN Trial

Sex‐Based Differences in the Performance of the HEART Score in Patients Presenting to the Emergency Department With Acute Chest Pain

Evaluation Efficacy of HEART Score in Prediction of Major Advanced Cardiac Events in Patients with Chest Pain

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