Title: The HEART score for ED patients with Chest Pain<br/>Author: Ali Farzad<br/><a href='http://umem.org/profiles/faculty/737/'>[Click to email author]</a><hr/><div class="gmail_default" style="color: rgb(0, 0, 0); font-family: arial, sans-serif; font-size: 13.333333969116211px;">
</div>
<div class="gmail_default" style="color: rgb(0, 0, 0); font-family: arial, sans-serif; font-size: 13.333333969116211px;">
<span style="line-height: 18px; color: rgb(42, 42, 42); font-family: georgia, serif;">The diagnosis of non-STE ACS can be difficult to exclude in ED patients with chest pain. Consequently, over-diagnosis </span><wbr style="line-height: 18px; color: rgb(42, 42, 42); font-family: georgia, serif;" /><span style="line-height: 18px; color: rgb(42, 42, 42); font-family: georgia, serif;">and unnecessary treatment are common. Risk stratification tools (ie. </span><a href="http://www.mdcalc.com/timi-risk-score-for-uanstemi/" style="line-height: 18px; font-family: georgia, serif; color: rgb(17, 85, 204);" target="_blank">TIMI</a><span style="line-height: 18px; color: rgb(42, 42, 42); font-family: georgia, serif;">, </span><a href="http://www.mdcalc.com/grace-acs-risk-and-mortality-calculator/" style="line-height: 18px; font-family: georgia, serif; color: rgb(17, 85, 204);" target="_blank">GRACE</a><span style="line-height: 18px; color: rgb(42, 42, 42); font-family: georgia, serif;">) have been created to help risk stratify ACS patients and predict mortality. However, they are of limited utility in the ED and do not effectively differentiate low to intermediate risk patients in all-comers with chest pain. </span></div>
<div class="gmail_default" style="color: rgb(0, 0, 0); font-family: arial, sans-serif; font-size: 13.333333969116211px;">
</div>
<div class="gmail_default" style="color: rgb(0, 0, 0); font-family: arial, sans-serif; font-size: 13.333333969116211px;">
<font face="georgia, serif"><font color="#2a2a2a"><span style="line-height: 18px;">The <a href="http://www.mdcalc.com/heart-score-for-major-cardiac-events/" style="color: rgb(17, 85, 204);" target="_blank">HEART score</a> was recently prospectively validated in an ED population and was able to quickly and </span></font><span style="color: rgb(42, 42, 42); line-height: 18px;">reliably predict risk of major adverse cardiac events (MACE - AMI, PCI, CABG, & Death). </span></font></div>
<div class="gmail_default" style="color: rgb(0, 0, 0); font-family: arial, sans-serif; font-size: 13.333333969116211px;">
<ul>
<li style="margin-left: 15px;">
<font face="georgia, serif"><font color="#2a2a2a"><span style="line-height: 18px;">5 practical considerations (<b>H</b>ist</span></font><span style="line-height: 18px; color: rgb(42, 42, 42);">ory, </span><font color="#2a2a2a"><span style="line-height: 18px;"><b>E</b>CG,<b> A</b>ge, <b>R</b>isk factors, & <b>T</b>roponin) are </span></font><span style="line-height: 18px; color: rgb(42, 42, 42);">scored (0,1,or 2 points each) </span><span style="line-height: 18px; color: rgb(42, 42, 42);">depending on the extent of the abnormality.</span></font></li>
<li style="margin-left: 15px;">
<font color="#2a2a2a" face="georgia, serif"><span style="line-height: 18px;">A HEART score (0-10) can be quickly determined without complex calculations</span></font></li>
<li style="margin-left: 15px;">
<span style="color: rgb(42, 42, 42); line-height: 18px;"><font face="georgia, serif">Low scores (0-3) exclude short term MACE with >98% certainty</font></span></li>
<li style="margin-left: 15px;">
<span style="line-height: 18px; color: rgb(42, 42, 42);"><font face="georgia, serif">High scores (7-10) have high (>50%) MACE rates</font></span></li>
<li style="margin-left: 15px;">
<font color="#2a2a2a" face="georgia, serif"><span style="line-height: 18px;">The HEART score performed significantly better than TIMI and GRACE scores </span></font></li>
</ul>
<font face="georgia, serif"><span style="line-height: 18px; color: rgb(42, 42, 42);"><b>Bottom-line:</b> The HEART score can help to objectively risk stratify ED patients with chest pain </span><span style="color: rgb(42, 42, 42); line-height: 18px;">into low, intermediate, and high risk groups</span><span style="line-height: 18px; color: rgb(42, 42, 42);">. Using the HEART score can also facilitate more efficient and effective communication with colleagues.</span></font></div>
<p>
</p>
<fieldset><legend>References</legend>
<p style="font-family: georgia, serif; font-size: small;">
Backus BE, Six AJ, Kelder JC, et al. A prospective validation of the HEART score for chest pain patients at the emergency department. <i>International Journal of Cardiology</i>. 2013;168(3):2153–2158. </p>
<p style="font-family: georgia, serif; font-size: small;">
Six AJ, Backus BE, Kelder JC. Chest pain in the emergency room: value of the HEART score. <i>Neth Heart J</i>. 2008;16(6):191–196.</p>
</fieldset><fieldset><legend>Attachments</legend>
International_Journal_of_Cardiology_2013_Backus.pdf (371 Kb)<br/><a href='http://umem.org/files/uploads/1312081410_International_Journal_of_Cardiology_2013_Backus.pdf' target='_blank'>http://umem.org/files/uploads/1312081410_International_Journal_of_Cardiology_2013_Backus.pdf</a><br/><br/>
Neth_Heart_J_2008_Six.pdf (144 Kb)<br/><a href='http://umem.org/files/uploads/1312081419_Neth_Heart_J_2008_Six.pdf' target='_blank'>http://umem.org/files/uploads/1312081419_Neth_Heart_J_2008_Six.pdf</a><br/><br/></fieldset>