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    HEART Score

    Cardiovascular

    Last Reviewed on Jun 05, 2021
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    By Kerry Walker,Manjot Kahlon

    Context

    • Approximately 80% of patients presenting to an ED with chest pain can be evaluated safely and ultimately discharged home.
    • The HEART Score is a well-validated risk stratification tool that allows earlier discharge of adult (> 21 years) chest pain patients concerning Acute Coronary Syndrome (ACS).
    • HEART = History, ECG, Age, Risk factors, Troponin.
    • It calculates the risk of a Major Adverse Cardiac Event (MACE)* within 6 weeks to identify.
    • MACE = all-cause mortality, coronary revascularization, or myocardial infarction.

    Diagnostic Process

    HEART Score

    • Both troponin and high-sensitivity troponin assays can be used with the HEART score, but a 2 – 3 hour high-sensitivity delta that is negative for ischemia and a low-risk HEART score decreases the MACE rate to 0.3%.
    • Limitations of the HEART score:
      • Subjective variation in scoring.
      • A patient can have an elevated troponin and still be low-risk.
      • ECG findings can be dynamic.

    Clinical Pitfalls

    • Applying the HEART score to the wrong patient population.
    • Do not use in patients:
      • Those < 21 years,
      • ST-Elevation Myocardial Infarction (STEMI),
      • Hypotensive,
      • Life-expectancy < 1 year.
    • Failure to consider further investigate patients with an elevated troponin in isolation (absence of any other risk factors) but have a low HEART score. Elevated troponin is evidence of myocardial cell death and should warrant investigation.

    Quality Of Evidence?

    Justification

    Several randomized control trials have validated the HEART score as a safe and effective clinical decision-making tool for evaluating patients with ACS. Studies have shown it has a negative predictive value >98% for those who have a low-risk score.

    High

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