Thomas Moumneh1, Benjamin C Sun2, Aileen Baecker3, Stacy Park3, Rita Redberg4, Maros Ferencik5, Ming-Sum Lee6, Delphine Douillet7, Pierre-Marie Roy7, Adam L Sharp8. 1. Département de Médecine d'Urgence, CHU d'Angers, Institut MITOVASC, UMR CNRS 6015 UMR INSERM 1083, Université d'Angers, Angers, France. Electronic address: thomas.moumneh@chu-angers.fr. 2. Department of Emergency Medicine, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia. 3. Kaiser Permanente Southern California, Department of Research & Evaluation, Pasadena. 4. Division of Cardiology, University of California, San Francisco. 5. Oregon Health and Science University, Knight Cardiovascular Institute, Portland. 6. Division of Cardiology, Kaiser Permanente Southern California, Los Angeles Medical Center. 7. Département de Médecine d'Urgence, CHU d'Angers, Institut MITOVASC, UMR CNRS 6015 UMR INSERM 1083, Université d'Angers, Angers, France. 8. Kaiser Permanente Southern California, Department of Research & Evaluation, Pasadena; Department of Health Systems Science, Kaiser Permanente School of Medicine, Pasadena.
Abstract
BACKGROUND: Current guidelines for patients with suspected acute myocardial infarction are mainly based on troponin testing, commonly requiring an emergency department visit. HEAR score (History, Electrocardiogram, Age, and Risk factors) is a risk stratification tool validated in Europe, deduced from the HEART score (History, Electrocardiogram, Age, Risk factors, and Troponin), already implemented in clinical practice. We aimed to validate the HEAR score to rule out an acute myocardial infarction without needing biomarker testing. METHODS: Retrospective cohort study at 15 emergency departments between May 2016 and December 2017. All adult encounters evaluated for possible acute myocardial infarction with a physician-documented HEART score for health plan members of Kaiser Permanente Southern California were included. Patients with an ST-segment elevation myocardial infarction, those under hospice care, or with a "do not resuscitate" status were excluded. HEAR scores from 0-8 were calculated for each encounter and used to report 30-day acute myocardial infarction or all-cause mortality for each score. RESULTS: There were 22,109 patient encounters included in the study. Overall, 30-day acute myocardial infarction or death occurred in 1.1% of patients. Among the 4106 patients (19%) with a HEAR score <2, 3 died and 2 experienced an acute myocardial infarction within 30 days (0.1%; 95% confidence interval, 0.1-0.3). Sensitivity and specificity were 97.9% and 18.8%, respectively. CONCLUSIONS: A low HEAR score may accurately identify patients with a very low risk of 30-day acute myocardial infarction or death, representing a cohort of patients who might appropriately forego biomarker testing. Future research is warranted to assess the impact of implementing the HEAR score into routine clinical practice.
BACKGROUND: Current guidelines for patients with suspected acute myocardial infarction are mainly based on troponin testing, commonly requiring an emergency department visit. HEAR score (History, Electrocardiogram, Age, and Risk factors) is a risk stratification tool validated in Europe, deduced from the HEART score (History, Electrocardiogram, Age, Risk factors, and Troponin), already implemented in clinical practice. We aimed to validate the HEAR score to rule out an acute myocardial infarction without needing biomarker testing. METHODS: Retrospective cohort study at 15 emergency departments between May 2016 and December 2017. All adult encounters evaluated for possible acute myocardial infarction with a physician-documented HEART score for health plan members of Kaiser Permanente Southern California were included. Patients with an ST-segment elevation myocardial infarction, those under hospice care, or with a "do not resuscitate" status were excluded. HEAR scores from 0-8 were calculated for each encounter and used to report 30-day acute myocardial infarction or all-cause mortality for each score. RESULTS: There were 22,109 patient encounters included in the study. Overall, 30-day acute myocardial infarction or death occurred in 1.1% of patients. Among the 4106 patients (19%) with a HEAR score <2, 3 died and 2 experienced an acute myocardial infarction within 30 days (0.1%; 95% confidence interval, 0.1-0.3). Sensitivity and specificity were 97.9% and 18.8%, respectively. CONCLUSIONS: A low HEAR score may accurately identify patients with a very low risk of 30-day acute myocardial infarction or death, representing a cohort of patients who might appropriately forego biomarker testing. Future research is warranted to assess the impact of implementing the HEAR score into routine clinical practice.
Authors: Chet D Schrader; Darren Kumar; Yuan Zhou; Stefan Meyering; Nicholas Saltarelli; Naomi Alanis; Chukwuagozie Iloma; Rebecca Smiley; Hao Wang Journal: BMC Cardiovasc Disord Date: 2022-03-04 Impact factor: 2.298