HEART Score and Its Implementation in Emergency Medicine Departments in the West Balkan Region—A Pilot Study

Abstract

Background: Chest pain represents a prevalent complaint in emergency departments (EDs), where the precise differentiation between acute coronary syndrome and alternative conditions assumes paramount significance. This pilot study aimed to assess the HEART score’s implementation in West Balkan EDs. Methods: A retrospective analysis was performed on a prospective cohort comprising patients presenting with chest pain admitted to EDs in Sarajevo, Zenica, and Belgrade between July and December 2022. Results: A total of 303 patients were included, with 128 classified as low-risk based on the HEART score and 175 classified as moderate-to-high-risk. The low-risk patients exhibited younger age and a lower prevalence of cardiovascular risk factors. Laboratory and anamnestic findings revealed higher levels of C-reactive protein, ALT, and creatinine, higher rates of moderately to highly suspicious chest pain history, a greater number of cardiovascular risk factors, and elevated troponin levels in moderate-to-high-risk patients. Comparatively, among patients with a low HEART score, 2.3% experienced MACE, whereas those with a moderate-to high-risk HEART score had a MACE rate of 10.2%. A moderate-to-high-risk HEART score demonstrated a sensitivity of 91.2% (95%CI 90.2–93.4%) and specificity of 46.5% (95%CI 39.9–48.3%) for predicting MACE. Conclusion: This pilot study offers preliminary insights into the integration of the HEART score within the emergency departments of the West Balkan region.

Assessment and Application of the Hear Score in Remote Emergency Medicine Outposts in Bosnia and Herzegovina

“…The results from secondary or tertiary healthcare facilities offer a valuable perspective on troponin levels among patients with high-risk HEAR scores, emphasizing positive implications for clinical practice [17]. It is noteworthy that a substantial proportion of these high-risk HEAR score patients exhibited troponin levels within the normal range.…”

“…This was carried out to establish contact and gather comprehensive details about the patient's medical condition, hospital admissions, occurrences of myocardial infarction, and revascularization procedures. Major Adverse Cardiovascular Events (MACE) were defined as a composite outcome, encompassing cardiovascular death, acute myocardial infarction (AMI), and revascularization, whether through percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) [17]. The selection of a 30-day follow-up period is crucial for capturing immediate post-acute events and complications that might occur shortly after an index event or intervention.…”

“…Our research aimed to introduce and implement the HEAR score, specifically, in remote primary care outposts in Bosnia and Herzegovina, after the presentation of the HEART score to the emergency medical departments of Bosnia and Herzegovina [17]. The subsequent phase involves gathering data on the prevalence of chest pain conditions, morbidity and mortality related to heart disease, and the outcomes based on the HEAR score.…”