A retrospective external validation study of the HEART score among patients presenting to the emergency department with chest pain

• DOI: 10.1007/s11739-017-1743-4
• Publication Date: 2019-04-16T06:02:40Z
• Authors: Matthew Jay Streitz; Joshua James Oliver; Jessica Marie Hyams; Richard Michael Wood; Yevgeniy Mikhaylo...; Brit Long; Robert Michael Ba...; Michael David April
• Keywords: Male; Chest Pain; Middle Aged; Risk Assessment; Decision Support Techniques; 3. Good health; Diagnosis, Differential; 03 medical and health sciences; 0302 clinical medicine; Cardiovascular Diseases; Predictive Value of Tests; Humans; Female; Emergency Service, Hospital; Retrospective Studies

Emergency physicians must be able to effectively prognosticate outcomes for patients presenting to the Emergency Department (ED) with chest pain. The HEART score offers a prognostication tool, but external validation studies are limited. We conducted an external retrospective validation study of the HEART score among ED patients presenting to our ED with chest pain from 1 January 2014 to 9 June 2014. We utilized chart review methodology to abstract data from each patient's electronic medical record. We collected data relevant to each of the five elements of the HEART score: history, electrocardiogram (ECG) interpretation, patient age, patient risk factors, and troponin levels. We calculated the diagnostic accuracy of the HEART score (0-10) for predicting the primary outcome of major adverse cardiac events (MACE) over 6 weeks following the ED visit (coronary revascularization, myocardial infarction, or mortality). We randomly selected 10% of patient charts from which a second investigator abstracted all data to assess inter-rater reliability for all study variables. Of 625 charts reviewed, we abstracted data on 417 (66.7%) consecutive patients meeting study inclusion criteria. Thirty-one (7.4%) of these patients experienced 6-week MACE. We observed no instances of MACE within 6 weeks among subjects with a HEART score of 3 or less. The area under the receiver operator curve (AUROC) is 0.885 (95% confidence interval 0.838-0.931). Patients with a HEART score ≤3 are at low risk for 6-week MACE. Hence, these patients may be candidates for outpatient follow-up instead of inpatient admission for cardiac risk stratification.