Patients' sex and race are independent predictors of HEART score documentation by emergency medicine providers

Check, R.; Kelly, Brian; Dunn, Erica H.; Stankewicz, Holly; Arner, Kate; Ridley, Kylie; Irick, Jennifer; Irick, Michael; Agresti, D.; Jeanmonod, Rebecca

doi:10.1016/j.ajem.2021.10.040

Cited by 3 publications

(1 citation statement)

References 19 publications

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“…As described in the methods section of this study, we only included patients who had a documented HEART score. Therefore, it is important to consider that a HEART score is only recorded 63.2% of the time for all patients presenting with chest pain within our health network and that younger age is an independent predictor of failure to perform risk stratification [ 15 ]. While this suggests that, in effect, HER scoring or a gestalt-based variant of this is already being applied in clinical practice to some extent, this limits the breadth of the patients enrolled in this study.…”

Section: Discussionmentioning

confidence: 99%

History, ECG, Risk Factors (HER) Scoring for Cardiac Risk Stratification in Patients <45 Years of Age Presenting With Chest Pain

Legare¹,

Dunn²,

Arner³

et al. 2023

Cureus

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Background Chest pain is a common chief complaint of patients presenting to the emergency department. Acute coronary syndrome (ACS) is found to be the etiology of this symptom in a minority of these patient encounters. This study aimed to determine the utility of using the History, ECG, Risk Factors (HER) components of the History, ECG, Age, Risk Factors, Troponin (HEART) score in ruling out 30-day Major Adverse Cardiac Event (MACE), ACS, ventricular tachycardia, and ventricular fibrillation in patients aged less than 45. Additionally, the utility of this score in ruling out a positive troponin was investigated as well. Methodology This is a retrospective chart review study that examined a consecutive cohort of 7,724 patients presenting with chest pain to the 11 emergency departments of a single healthcare system over a two-year period (January 2019 to December 2020). HER scores of 0 to 1 were categorized as negative (-) and scores of two or greater were categorized as positive (+). Sensitivity, specificity, and predictive values were calculated for the relationship between HER score positivity and primary cardiac disease and troponin results. Results Test characteristics of HER scoring for significant primary cardiac disease in patients between 18 and 45 years of age presenting with undifferentiated chest pain were sensitivity of 88.0 (CI = 80.0-94.0), specificity of 72.6 (CI = 71.8-73.8), positive predictive value of 3.1 (CI = 2.4-3.9), and negative predictive value of 99.8 (CI = 99.7-99.9). Furthermore, an HER score >1 was neither sensitive nor specific in predicting a positive troponin (sensitivity = 80, CI = 71.9-86; specificity = 71.3, CI = 70.3-72.3). However, the negative predictive value of an HER score of 0-1 was 99.5 (CI = 99.3-99.7) and the positive predictive value was 4.7 (CI = 3.9-5.7). Conclusions According to this study, when evaluating young patients who are deemed to have a subjectively non-highly suspicious history, who have minimal risk factors, and who have an ECG without significant ST deviation, troponin testing is low yield in the risk stratification of patients under the age of 45 for serious primary cardiac disease.

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Section: Discussionmentioning

confidence: 99%

History, ECG, Risk Factors (HER) Scoring for Cardiac Risk Stratification in Patients <45 Years of Age Presenting With Chest Pain

Legare¹,

Dunn²,

Arner³

et al. 2023

Cureus

Self Cite

View full text Add to dashboard Cite

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Influence of Patient and Clinician Gender on Emergency Department HEART Scores: A Secondary Analysis of a Prospective Observational Trial

Barron

Mader

Knee

et al. 2024

Annals of Emergency Medicine

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Role of HEART score in prediction of coronary artery disease and major adverse cardiac events in patients presenting with chest pain

Stojković¹,

Stojkovic²,

Sakač

et al. 2022

Srp Arh Celok Lek

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Introduction. Chest pain (CP) diagnostics accuracy remains debatable for both general practitioners (GP) or emergency department (ED) physicians for patients in HEART score (HS) low- and intermediate-risk groups which prompted us to review our electronic database for all patients admitted via our center?s ED during 2014 to 2020 for CP and suspect acute coronary syndrome. Methods. Patients were divided in function of low- or intermediate-risk HS and assessed during a three month follow up for angiogram results, MACE, lab results and echo parameters. Results. Of 585 patients included, low-risk HS group (21,4%, 36% were women) had significant coronary disease on angiogram in 68%, while for intermediate-risk HS group (78.6%, with 32.6% women) it was for 18.4% of patients (p < 0,0005). Area under the ROC curve of HS in detecting patients with ischemic heart disease as a cause of CP was 0.771 (95% CI:0.772-0.820) with best cut-off point HS was calculated at 3.5. Sensitivity and specificity were 89.2% and 57.6% respectively. Adjusting for sex, lab results and HS, AUROC curve of this model was 0.828 (95% CI:0.786-0.869; p < 0,0005) with cut-off of 77.95. Sensitivity and specificity were 84,9% and 68% respectively. In the three-month follow-up post-discharge, there was a significant difference in MACE between groups (low-vs. intermediate-risk HS was 3.4 vs. 16.7% p < 0.05). Conclusion. HS for our CP patients admitted via our ED by GP and ED physicians? referral, provides a quick and reliable prediction of ischemic heart disease and MACE.

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Patients' sex and race are independent predictors of HEART score documentation by emergency medicine providers

Cited by 3 publications

References 19 publications

History, ECG, Risk Factors (HER) Scoring for Cardiac Risk Stratification in Patients <45 Years of Age Presenting With Chest Pain

History, ECG, Risk Factors (HER) Scoring for Cardiac Risk Stratification in Patients <45 Years of Age Presenting With Chest Pain

Influence of Patient and Clinician Gender on Emergency Department HEART Scores: A Secondary Analysis of a Prospective Observational Trial

Role of HEART score in prediction of coronary artery disease and major adverse cardiac events in patients presenting with chest pain

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