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

Abstract

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.

Prognostic Accuracy of the HEART Score for Prediction of Major Adverse Cardiac Events in Patients Presenting With Chest Pain: A Systematic Review and Meta‐analysis

“…Our search identified 778 citations (Figure ) and following removal of duplicates, we screened 557 studies, from which 62 studies underwent full‐text review. We included 29 distinct cohorts from 30 studies in the meta‐analysis . All included studies evaluated the prognostic accuracy of the HEART score using a low‐risk threshold (score between 0 and 3).…”

“…There were 17 (56.7%) retrospective cohorts, 11 (36.7%) prospective cohorts, and two (6.7%) randomized trials. Sixteen studies evaluated the HEART score for 30‐day incidence of MACE, while 13 evaluated the HEART score for 6‐week incidence of MACE . Most studies included only patients presenting with chest pain, while five studies included patients presenting with “suspected ACS.” In 14 studies, the ECG was interpreted by an ED physician, while in seven studies the ECG was specifically interpreted by a cardiologist .…”

Predictive value of HEART score in the outcome of acute coronary syndrome and disposition

“…Backus et al in 2013, estimated a HEART score of 6.54 in positive MACE, while the score was 3.96 in negative MACE (19). In Bolvardi et al study, a similar result was observed: 7.42 in positive MACE and 5.42 in negative MACE (2).…”

“…Clinicians can decide whether to release and discharge patients or admit them for further evaluations (16). In previous studies, it is reported that there is a significant difference in the predictive value of HEART score comparing to other scoring tools (2,15). Literature still needs more research in this field to estimate the exact value of HEART score in patients' disposition in ED.…”

“…Chest pain is one of the most common presentations in the emergency department (ED), about 6.3% of ED visits (1). There is a great deal of differential diagnosis when facing a patient with the chest pain, acute coronary syndrome (ACS), pulmonary emboli, vascular events, and noncardiac presentations (2,3). In an overcrowded environment such as an ED, it is essential and vital to find patients with major cardiac events (especially acute myocardial infarction, AMI) as soon as possible in order to limit the adverse events and mortality with the best management.…”