Clinical Outcomes of Out of Hospital Cardiac Arrest and Cardiogenic Shock Patients

Abstract

Background: The modified HEART score has been validated to accurately risk stratify patients presenting to the Emergency Department (ED) with chest pain, however, its ability to predict outcomes has not been evaluated against standard clinical assessment. Objective: This study compared standard care by clinical assessment alone to modified HEART score to evaluate which method was superior in predicting cardiovascular events in patients presenting with acute chest pain. Methodology: A retrospective cohort study of all chest pain presentations was performed over three months. Patients were excluded if they had ST elevation infarct or an alternative cause of chest pain. Major adverse cardiovascular events (MACE) outcomes assessed included acute coronary syndrome (ACS), unplanned revascularisation, readmission for heart failure and cardiovascular death. These were assessed at 12 months, and statistical significance determined by Chisquared test. Results: A total of 199 patients were included. Of those, 12 (6%) had ACS at index admission, 16 (8%) at six weeks and 23 (12%) at twelve months. At twelve months, the modified HEART score demonstrated higher sensitivity for predicting MACE compared with standard care alone (96% vs 74%; p = 0.03), however, specificity was higher with standard care compared to modified HEART score (74% vs 53%; p < 0.0001). Conclusions: Modified HEART score provided higher sensitivity but lower specificity than clinical assessment alone in predicting cardiovascular events in patients presenting to ED with chest pain. The modified HEART score is of potential use to more accurately exclude ACS in the emergency department compared to standard clinical assessment alone.