The HEART score as a prognostic tool for revascularization

Abstract

The History, Electrocardiogram, Age, Risk Factors, Troponin (HEART) score is a useful tool in the Emergency Department setting to identify those patients safe for outpatient evaluation of chest pain. Its utility for predicting cardiac interventions is unclear. Our objective was to evaluate the prognostic accuracy of the HEART score to predict the need for cardiac stent or coronary artery bypass grafting (CABG). We conducted a retrospective chart review of 625 consecutive subjects with chest pain presenting to an Emergency Department (ED) with a HEART pathway protocol in place. We also reviewed each subject’s record for evidence of major adverse cardiac events within 6 weeks following their ED visit. We double-abstracted 10% of the charts for quality assurance. We included subjects if they were ≥ 18 at the time of presentation and had a chief complaint of chest pain. We excluded subjects if they did not have an electrocardiogram or troponin, or if their chart lacked sufficient information to calculate the history portion of their HEART score. Of 625 charts, 449 subjects met criteria for study inclusion. The area under the receiver operator curve reported as c-statistics was 0.877 [95% confidence interval (CI) 0.806–0.949] for the HEART score’s ability to predict cardiac stent and 0.921 (95% CI 0.858–0.984) for CABG. There is a strong association between increasing HEART scores and the need for revascularization which may provide emergency physicians justification for expedited cardiology consultation and admission for these patients. These findings require further prospective validation.