BACKGROUND: 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). The HEART score was designed to facilitate this process. This study is a prospective validation of the HEART score. METHODS: A total of 2440 unselected patients presented with chest pain at the cardiac emergency department of ten participating hospitals in The Netherlands. The HEART score was assessed as soon as the first lab results and ECG were obtained. Primary endpoint was the occurrence of major adverse cardiac events (MACE) within 6 weeks. Secondary endpoints were (i) the occurrence of AMI and death, (ii) ACS and (iii) the performance of a coronary angiogram. The performance of the HEART score was compared with the TIMI and GRACE scores. RESULTS: Low HEART scores (values 0-3) were calculated in 36.4% of the patients. MACE occurred in 1.7%. In patients with HEART scores 4-6, MACE was diagnosed in 16.6%. In patients with high HEART scores (values 7-10), MACE occurred in 50.1%. The c-statistic of the HEART score (0.83) is significantly higher than the c-statistic of TIMI (0.75)and GRACE (0.70) respectively (p<0.0001). CONCLUSION: The HEART score provides the clinician with a quick and reliable predictor of outcome, without computer-required calculating. Low HEART scores (0-3), exclude short-term MACE with >98% certainty. In these patients one might consider reserved policies. In patients with high HEART scores (7-10) the high risk of MACE may indicate more aggressive policies.
BACKGROUND: The focus of the diagnostic process in chest painpatients at the emergency department is to identify both low and high risk patients for an acute coronary syndrome (ACS). The HEART score was designed to facilitate this process. This study is a prospective validation of the HEART score. METHODS: A total of 2440 unselected patients presented with chest pain at the cardiac emergency department of ten participating hospitals in The Netherlands. The HEART score was assessed as soon as the first lab results and ECG were obtained. Primary endpoint was the occurrence of major adverse cardiac events (MACE) within 6 weeks. Secondary endpoints were (i) the occurrence of AMI and death, (ii) ACS and (iii) the performance of a coronary angiogram. The performance of the HEART score was compared with the TIMI and GRACE scores. RESULTS: Low HEART scores (values 0-3) were calculated in 36.4% of the patients. MACE occurred in 1.7%. In patients with HEART scores 4-6, MACE was diagnosed in 16.6%. In patients with high HEART scores (values 7-10), MACE occurred in 50.1%. The c-statistic of the HEART score (0.83) is significantly higher than the c-statistic of TIMI (0.75)and GRACE (0.70) respectively (p<0.0001). CONCLUSION: The HEART score provides the clinician with a quick and reliable predictor of outcome, without computer-required calculating. Low HEART scores (0-3), exclude short-term MACE with >98% certainty. In these patients one might consider reserved policies. In patients with high HEART scores (7-10) the high risk of MACE may indicate more aggressive policies.
Authors: Simon A Mahler; Jason P Stopyra; Fred S Apple; Robert F Riley; Gregory B Russell; Brian C Hiestand; James W Hoekstra; Cedric W Lefebvre; Bret A Nicks; David M Cline; Kim L Askew; David M Herrington; Gregory L Burke; Chadwick D Miller Journal: Clin Biochem Date: 2017-01-10 Impact factor: 3.281
Authors: Stephanie O Frisch; Julissa Brown; Ziad Faramand; Jennifer Stemler; Ervin Sejdić; Christian Martin-Gill; Clifton Callaway; Susan M Sereika; Salah S Al-Zaiti Journal: Res Nurs Health Date: 2020-06-03 Impact factor: 2.228
Authors: Teresa Infante; Ernesto Forte; Concetta Schiano; Carlo Cavaliere; Carlo Tedeschi; Andrea Soricelli; Marco Salvatore; Claudio Napoli Journal: Am J Transl Res Date: 2017-07-15 Impact factor: 4.060
Authors: Salah S Al-Zaiti; Ziad Faramand; Mohammad O Alrawashdeh; Susan M Sereika; Christian Martin-Gill; Clifton Callaway Journal: Am J Emerg Med Date: 2018-06-08 Impact factor: 2.469
Authors: Adam L Sharp; Yi-Lin Wu; Ernest Shen; Rita Redberg; Ming-Sum Lee; Maros Ferencik; Shaw Natsui; Chengyi Zheng; Aniket Kawatkar; Michael K Gould; Benjamin C Sun Journal: J Am Coll Cardiol Date: 2018-10-09 Impact factor: 24.094
Authors: Nicholas D Hartman; Erin N Harper; Lauren M Leppert; Brittany M Browning; Kim Askew; David E Manthey; Simon A Mahler Journal: J Healthc Qual Date: 2018 Jan/Feb Impact factor: 1.095