UMEM Educational Pearls

Title: The HEART score for ED patients with Chest Pain

Keywords: ACS, Chest Pain, HEART score (PubMed Search)

Posted: 12/8/2013 by Ali Farzad, MD (Updated: 3/10/2014)
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The diagnosis of non-STE ACS can be difficult to exclude in ED patients with chest pain. Consequently, over-diagnosis and unnecessary treatment are common. Risk stratification tools (ie. TIMI, GRACE) 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.

The HEART score was recently prospectively validated in an ED population and was able to quickly and reliably predict risk of major adverse cardiac events (MACE - AMI, PCI, CABG, & Death).

5 practical considerations (History, ECG, Age, Risk factors, & Troponin) are scored (0,1,or 2 points each) depending on the extent of the abnormality.
A HEART score (0-10) can be quickly determined without complex calculations
Low scores (0-3) exclude short term MACE with >98% certainty
High scores (7-10) have high (>50%) MACE rates
The HEART score performed significantly better than TIMI and GRACE scores

Bottom-line: The HEART score can help to objectively risk stratify ED patients with chest pain into low, intermediate, and high risk groups. Using the HEART score can also facilitate more efficient and effective communication with colleagues.

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References

Backus BE, Six AJ, Kelder JC, et al. A prospective validation of the HEART score for chest pain patients at the emergency department. International Journal of Cardiology. 2013;168(3):2153–2158.

Six AJ, Backus BE, Kelder JC. Chest pain in the emergency room: value of the HEART score. Neth Heart J. 2008;16(6):191–196.

Attachments

1312081410_International_Journal_of_Cardiology_2013_Backus.pdf (371 Kb)

1312081419_Neth_Heart_J_2008_Six.pdf (144 Kb)