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Schrader CD, Kumar D, Zhou Y, Meyering S, Saltarelli N, Alanis N, Iloma C, Smiley R, Wang H. Using HEART2 score to risk stratify chest pain patients in the Emergency Department: an observational study. BMC Cardiovasc Disord 2022; 22:79. [PMID: 35246065 PMCID: PMC8896146 DOI: 10.1186/s12872-022-02528-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 02/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A significant number of chest pain patients had previous cardiac imaging tests (CIT) performed before being presented to the Emergency Department (ED). The HEART (history, electrocardiogram, age, risk factors, and troponin) score has been used to risk-stratify chest pain patients in the ED, but not particularly for patients with CIT performed. We aim to modify the current HEART score with the addition of most recent CIT findings (referred to as HEART2 score), to predict a 30-day major adverse cardiac event (MACE) among ED chest pain patients, compare the performance accuracy of using HEART versus HEART2 score for 30-day MACE outcome predictions, and further determine the value of HEART2 in a subset group of ED chest pain patients (i.e., ones with previous CIT). METHODS This is a single-center observational study. We included chest pain patients with HEART scores calculated during their index ED visits. A modified HEART2 score was developed with the addition of CIT findings as one of the HEART2 components. Patients were divided into three groups, including low (≤ 3), moderate (4-6), and high-risk HEART/HEART2 scores (≥ 7). MACE occurrence of a patient with different risks of HEART and HEART2 scores and overall performance accuracy of HEART versus HEART2 score predicting MACE outcomes were compared. RESULTS We included a total of 9419 chest pain patients at ED, among which one out of five patients (1874/9419) had previous CIT performed. Fewer (38.2%) of such patients had low-risk HEART scores in comparison to 55.5% of low-risk HEART2 scores (p < 0.001). The MACE outcomes were similar in low-risk HEART patients compared with low-risk HEART2 patients (2.2% versus 3.1%, p = 0.3021). The overall performance accuracy of using the HEART2 score to stratify chest pain patients with previous CIT was better than using the HEART score's (AUC 0.74 versus 0.71, p = 0.0082). CONCLUSIONS Using the HEART2 score might be suitable to stratify low-to-moderate risk chest pain patients at ED with a similar 30-days MACE occurrence compared to the HEART score. More importantly, with the use of similar low-risk criteria (HEART2 ≤ 3), over 45% more chest pain patients with previous CIT performed could be discharged directly from ED.
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Affiliation(s)
- Chet D Schrader
- Department of Emergency Medicine, John Peter Smith Health Network (JPS Health Network), 1500 S. Main St., Fort Worth, TX, 76104, USA
| | - Darren Kumar
- Department of Cardiology, JPS Health Network, 1500 S. Main St., Fort Worth, TX, 76104, USA
| | - Yuan Zhou
- Department of Industrial, Manufacturing, and Systems Engineering, The University of Texas at Arlington, 701 S. Nedderman Dr., Arlington, TX, 76019, USA
| | - Stefan Meyering
- Department of Emergency Medicine, John Peter Smith Health Network (JPS Health Network), 1500 S. Main St., Fort Worth, TX, 76104, USA
| | - Nicholas Saltarelli
- Department of Emergency Medicine, John Peter Smith Health Network (JPS Health Network), 1500 S. Main St., Fort Worth, TX, 76104, USA
| | - Naomi Alanis
- Department of Emergency Medicine, John Peter Smith Health Network (JPS Health Network), 1500 S. Main St., Fort Worth, TX, 76104, USA
| | - Chukwuagozie Iloma
- Department of Emergency Medicine, John Peter Smith Health Network (JPS Health Network), 1500 S. Main St., Fort Worth, TX, 76104, USA
| | - Rebecca Smiley
- Department of Emergency Medicine, John Peter Smith Health Network (JPS Health Network), 1500 S. Main St., Fort Worth, TX, 76104, USA
| | - Hao Wang
- Department of Emergency Medicine, John Peter Smith Health Network (JPS Health Network), 1500 S. Main St., Fort Worth, TX, 76104, USA.
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Role of HEART score in prediction of coronary artery disease and major adverse cardiac events in patients presenting with chest pain. SRP ARK CELOK LEK 2022. [DOI: 10.2298/sarh220213038s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Introduction. Chest pain (CP) diagnostics accuracy remains
debatable for both general practitioners (GP) or emergency department (ED)
physicians for patients in HEART score (HS) low- and intermediate-risk
groups which prompted us to review our electronic database for all patients
admitted via our center?s ED during 2014 to 2020 for CP and suspect acute
coronary syndrome. Methods. Patients were divided in function of low- or
intermediate-risk HS and assessed during a three month follow up for
angiogram results, MACE, lab results and echo parameters. Results. Of 585
patients included, low-risk HS group (21,4%, 36% were women) had significant
coronary disease on angiogram in 68%, while for intermediate-risk HS group
(78.6%, with 32.6% women) it was for 18.4% of patients (p < 0,0005). Area
under the ROC curve of HS in detecting patients with ischemic heart disease
as a cause of CP was 0.771 (95% CI:0.772-0.820) with best cut-off point HS
was calculated at 3.5. Sensitivity and specificity were 89.2% and 57.6%
respectively. Adjusting for sex, lab results and HS, AUROC curve of this
model was 0.828 (95% CI:0.786-0.869; p < 0,0005) with cut-off of 77.95.
Sensitivity and specificity were 84,9% and 68% respectively. In the
three-month follow-up post-discharge, there was a significant difference in
MACE between groups (low-vs. intermediate-risk HS was 3.4 vs. 16.7% p <
0.05). Conclusion. HS for our CP patients admitted via our ED by GP and ED
physicians? referral, provides a quick and reliable prediction of ischemic
heart disease and MACE.
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