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HWN Suggests

The HEART Score's Blind Spots

The HEART score is a great guideline, supported by the literature, but it is often just not nuanced enough to be applied to certain patients. A 44-year-old man with untreated hypertension who smokes and comes to the ED with three days of unstable angina but a normal ECG and troponin might get a HEART score of 2 but actually be a very high-risk patient to send home. HEART score documentation might protect you in a lawsuit if there is a bad outcome, but wouldn't you prefer to save the patient and avoid a bad outcome?

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Articles of Interest

HEART Score for Major Cardiac Events

Predicts 6-week risk of major adverse cardiac event. Use in patients ≥21 years old presenting with symptoms suggestive of ACS. Do not use if new ST-segment elevation ≥1 mm or other new EKG changes, hypotension, life expectancy less than 1 year, or noncardiac medical/surgical/psychiatric illness determined by the provider to require admission.

The HEART Score

The HEART score has been validated in several studies and has proven to be a powerful, easy, and above all practical instrument to separate patients into a low, medium and high risk groups. Patients scoring 0-3 have a 1.6% chance of experiencing a cardiac event, those with a score 4-6 have a 13% chance, and those scoring 7 or higher have a 50% chance of developing a myocardial infarction, PTCA, CABG or death within 6 weeks following presentation.

The Real-World Calculation of the HEART Score

ED clinicians had only moderate agreement with research HEART scores. Combined with uncertainties regarding accuracy in predicting major adverse cardiac events, we urge caution in the widespread use of the HEART score as the sole determinant of ED disposition.

A Closer Look at the HEART Score

The history, electrocardiogram, age, risk factors, and troponin (HEART) score is currently a widely used tool for acute chest pain risk stratification. Relatively soon after its inception in 2008, a number of validation studies on the HEART score showed it to be superior to Thrombolysis in Myocardial Infarction (TIMI) and Global Registry of Acute Coronary Events (GRACE) scores and at least as accurate to other existing scores for predicting short-term major adverse cardiovascular events (MACEs). However, partly due to its focus on simplicity, the HEART score has some limitations.

A Methodological Appraisal of the HEART Score and Its Variants

In summary, despite its need and simplicity, the HEART score and its variants have clinically important weaknesses in creation, structure, interrater reliability, and outcome selection and omit consideration of the timeliness or likelihood of meaningful physician follow-up. Their test sensitivity is below the threshold that emergency physicians state a willingness to accept. We believe that the widespread use of the HEART score and its variants should be reconsidered.

A modified HEART risk score in chest pain patients with suspected non-ST-segment elevation acute coronary syndrome

In conclusion, the modified HEART risk score was validated in chest pain patients with suspected NSTE-ACS and may complement MACE risk assessment and patients triage in the ED. A prospective study of the score is warranted.

Chest pain in the emergency room: value of the HEART score

The HEART score is an easy, quick and reliable predictor of outcome in chest pain patients and can therefore be used for triage.

HEART Pathway for Early Discharge in Acute Chest Pain

Identifies emergency department patients with acute chest pain for early discharge.

The Real-World Calculation of the HEART Score

ED clinicians had only moderate agreement with research HEART scores. Combined with uncertainties regarding accuracy in predicting major adverse cardiac events, we urge caution in the widespread use of the HEART score as the sole determinant of ED disposition.