OBJECTIVES: The History, Electrocardiography, Age, Risk factors, Troponin (HEART) score enables rapid risk stratification of emergency department patients presenting with chest pain. However, the subjectivity in scoring introduced by the history component has been criticized by some clinicians. We examined the association of 3 objective scoring models with the results of noninvasive cardiac testing. METHODS: Medical records for all patients evaluated in the chest pain center of an academic medical center during a 1-year period were reviewed retrospectively. Each patient's history component score was calculated using 3 models developed by the authors. Differences in the distribution of HEART scores for each model, as well as their degree of agreement with one another, as well as the results of cardiac testing were analyzed. RESULTS: Seven hundred forty nine patients were studied, 58 of which had an abnormal stress test or computed tomography coronary angiography. The mean HEART scores for models 1, 2, and 3 were 2.97 (SD 1.17), 2.57 (SD 1.25), and 3.30 (SD 1.35), respectively, and were significantly different (P < 0.001). However, for each model, the likelihood of an abnormal cardiovascular test did not correlate with higher scores on the symptom component of the HEART score (P = 0.09, 0.41, and 0.86, respectively). CONCLUSIONS: While the objective scoring models produced different distributions of HEART scores, no model performed well with regards to identifying patients with abnormal advanced cardiac studies in this relatively low-risk cohort. Further studies in a broader cohort of patients, as well as comparison with the performance of subjective history scoring, is warranted before adoption of any of these objective models.
OBJECTIVES: The History, Electrocardiography, Age, Risk factors, Troponin (HEART) score enables rapid risk stratification of emergency department patients presenting with chest pain. However, the subjectivity in scoring introduced by the history component has been criticized by some clinicians. We examined the association of 3 objective scoring models with the results of noninvasive cardiac testing. METHODS: Medical records for all patients evaluated in the chest pain center of an academic medical center during a 1-year period were reviewed retrospectively. Each patient's history component score was calculated using 3 models developed by the authors. Differences in the distribution of HEART scores for each model, as well as their degree of agreement with one another, as well as the results of cardiac testing were analyzed. RESULTS: Seven hundred forty nine patients were studied, 58 of which had an abnormal stress test or computed tomography coronary angiography. The mean HEART scores for models 1, 2, and 3 were 2.97 (SD 1.17), 2.57 (SD 1.25), and 3.30 (SD 1.35), respectively, and were significantly different (P < 0.001). However, for each model, the likelihood of an abnormal cardiovascular test did not correlate with higher scores on the symptom component of the HEART score (P = 0.09, 0.41, and 0.86, respectively). CONCLUSIONS: While the objective scoring models produced different distributions of HEART scores, no model performed well with regards to identifying patients with abnormal advanced cardiac studies in this relatively low-risk cohort. Further studies in a broader cohort of patients, as well as comparison with the performance of subjective history scoring, is warranted before adoption of any of these objective models.
Authors: Paul A Harris; Robert Taylor; Robert Thielke; Jonathon Payne; Nathaniel Gonzalez; Jose G Conde Journal: J Biomed Inform Date: 2008-09-30 Impact factor: 6.317
Authors: Simon A Mahler; Robert F Riley; Gregory B Russell; Brian C Hiestand; James W Hoekstra; Cedric W Lefebvre; Bret A Nicks; David M Cline; Kim L Askew; John Bringolf; Stephanie B Elliott; David M Herrington; Gregory L Burke; Chadwick D Miller Journal: Acad Emerg Med Date: 2015-12-31 Impact factor: 3.451
Authors: Simon A Mahler; Robert F Riley; Brian C Hiestand; Gregory B Russell; James W Hoekstra; Cedric W Lefebvre; Bret A Nicks; David M Cline; Kim L Askew; Stephanie B Elliott; David M Herrington; Gregory L Burke; Chadwick D Miller Journal: Circ Cardiovasc Qual Outcomes Date: 2015-03-03
Authors: Barbra E Backus; A Jacob Six; Johannes C Kelder; Thomas P Mast; Frederieke van den Akker; E Gijis Mast; Stefan H J Monnink; Rob M van Tooren; Pieter A F M Doevendans Journal: Crit Pathw Cardiol Date: 2010-09
Authors: Tonje R Johannessen; Dan Atar; Odd Martin Vallersnes; Anne Cecilie K Larstorp; Ibrahimu Mdala; Sigrun Halvorsen Journal: BMJ Open Date: 2021-02-24 Impact factor: 2.692