
Comparison of usual care and the HEART score for effectively and safely discharging patients with low‐risk chest pain in the emergency department: would the score always help?
Author(s) -
Wang Guangmei,
Zheng Wen,
Wu Shuo,
Ma Jingjing,
Zhang He,
Zheng Jiaqi,
Wang Jiali,
Xu Feng,
Chen Yuguo
Publication year - 2020
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.23325
Subject(s) - medicine , mace , emergency department , chest pain , myocardial infarction , framingham risk score , triage , acute coronary syndrome , troponin , population , emergency medicine , heart failure , unstable angina , cardiology , intensive care medicine , physical therapy , percutaneous coronary intervention , disease , environmental health , psychiatry
Background Triage decisions for chest pain patients receiving usual care are based on a dynamic and comprehensive strategy performed in the physician's mind. It remains controversial whether simple, structured risk tools can surpass real, complex judgments. Hypothesis The potentially used History, Electrocardiogram, Age, Risk factors, Troponin (HEART) score would help identify low‐risk patients for discharge. Methods Patients with acute, non‐traumatic chest pain managed according to usual care were consecutively enrolled in a tertiary university hospital in China from August 24, 2015 to September 30, 2017. Major adverse cardiac events (MACE) included death, acute myocardial infarction, revascularization, and significant coronary stenosis (>50%) within 30 days. We compared the efficacy and safety of usual care and the potentially used HEART score in this population. Results Of 2185 patients analyzed, 926 (42.4%) patients were directly discharged by usual care, whereas HEART≤3 would have identified 524 (24.0%) patients as low‐risk ( P < .001). The MACE rate in discharged patients was 2.2% (20/926) and would have been 5.2% (27/524) in those with HEART≤3 ( P = .002). For discharged patients, the MACE rates in HEART≤3 vs HEART>3 groups were not significantly different (1.5% vs 2.7%, P = .225). Negative predictive value (NPV) was higher with usual care than with the HEART score ( P = .003), but sensitivity was similar. For 340 patients with serial troponins, usual care was superior to the potentially used HEART score in regard to efficacy. Conclusions At this institution, usual care identified many more patients for discharge than the HEART score would have without apparently different outcomes in discharged patients with lower vs higher HEART scores. The HEART score would not appear to provide helpful risk stratification.