- Approximately 80% of patients presenting to an ED with chest pain can be evaluated safely and ultimately discharged home.
- The HEART Score is a well-validated risk stratification tool that allows earlier discharge of adult (> 21 years) chest pain patients concerning Acute Coronary Syndrome (ACS).
- HEART = History, ECG, Age, Risk factors, Troponin.
- It calculates the risk of a Major Adverse Cardiac Event (MACE)* within 6 weeks to identify.
- MACE = all-cause mortality, coronary revascularization, or myocardial infarction.
- Both troponin and high-sensitivity troponin assays can be used with the HEART score, but a 2 – 3 hour high-sensitivity delta that is negative for ischemia and a low-risk HEART score decreases the MACE rate to 0.3%.
- Limitations of the HEART score:
- Subjective variation in scoring.
- A patient can have an elevated troponin and still be low-risk.
- ECG findings can be dynamic.
- Applying the HEART score to the wrong patient population.
- Do not use in patients:
- Those < 21 years,
- ST-Elevation Myocardial Infarction (STEMI),
- Life-expectancy < 1 year.
- Failure to consider further investigate patients with an elevated troponin in isolation (absence of any other risk factors) but have a low HEART score. Elevated troponin is evidence of myocardial cell death and should warrant investigation.
Quality Of Evidence?
We are highly confident that the true effect lies close to that of the estimate of the effect. There is a wide range of studies included in the analyses with no major limitations, there is little variation between studies, and the summary estimate has a narrow confidence interval.
We consider that the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. There are only a few studies and some have limitations but not major flaws, there are some variations between studies, or the confidence interval of the summary estimate is wide.
When the true effect may be substantially different from the estimate of the effect. The studies have major flaws, there is important variations between studies, of the confidence interval of the summary estimate is very wide.
Several randomized control trials have validated the HEART score as a safe and effective clinical decision-making tool for evaluating patients with ACS. Studies have shown it has a negative predictive value >98% for those who have a low-risk score.
Fernando SM, Tran A, Cheng W, et al. Prognostic accuracy of the HEART score for prediction of major adverse cardiac events in patients presenting with chest pain: a systematic review and meta-analysis. Acad Emerg Med2019; 26: 140– 51 [doi: 1111/acem.13649]
OTHER RELEVANT INFORMATION
The purpose of this document is to provide health care professionals with key facts and recommendations for the diagnosis and treatment of patients in the emergency department. This summary was produced by the BC Emergency Medicine Network and uses the best available knowledge at the time of publication. However, healthcare professionals should continue to use their own judgment and take into consideration context, resources and other relevant factors. The BC Emergency Medicine Network is not liable for any damages, claims, liabilities, costs or obligations arising from the use of this document including loss or damages arising from any claims made by a third party. The BC Emergency Medicine Network also assumes no responsibility or liability for changes made to this document without its consent.
Last Updated Jun 05, 2021
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