Document Detail


Can the HEART score safely reduce stress testing and cardiac imaging in patients at low risk for major adverse cardiac events?
MedLine Citation:
PMID:  21989033     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Patients with low-risk chest pain have high utilization of stress testing and cardiac imaging, but low rates of acute coronary syndrome (ACS). The objective of this study was to determine whether the HEART score could safely reduce objective cardiac testing in patients with low-risk chest pain.
METHODS: A cohort of chest pain patients was identified from an emergency department-based observation unit registry. HEART scores were determined using registry data elements and blinded chart review. HEART scores were dichotomized into low (0-3) or high risk (>3). The outcome was major adverse cardiac events (MACE); a composite end point of all-cause mortality, myocardial infarction, or coronary revascularization during the index visit or within 30 days. Sensitivity, specificity, and potential reduction of cardiac testing were calculated.
RESULTS: In a span of 28 months, the registry included 1070 low-risk chest pain patients. MACE occurred in 0.6% (5/904) of patients with low-risk HEART scores compared with 4.2% (7/166) with a high-risk HEART scores (odds ratio = 7.92; 95% confidence interval [95% CI]: 2.48-25.25). A HEART score of >3 was 58% sensitive (95% CI: 32-81%) and 85% specific (95% CI: 83-87%) for MACE. The HEART score missed 5 cases of ACS among 1070 patients (0.5%) and could have reduced cardiac testing by 84.5% (904/1070). Combination of serial troponin >0.065 ng/mL or HEART score >3 resulted in sensitivity of 100% (95% CI: 72-100%), specificity of 83% (95% CI: 81-85%), and potential reduction in cardiac testing of 82% (879/1070).
CONCLUSIONS: If used to guide stress testing and cardiac imaging, the HEART score could substantially reduce cardiac testing in a population with low pretest probability of ACS.
Authors:
Simon A Mahler; Brian C Hiestand; David C Goff; James W Hoekstra; Chadwick D Miller
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Critical pathways in cardiology     Volume:  10     ISSN:  1535-2811     ISO Abbreviation:  Crit Pathw Cardiol     Publication Date:  2011 Sep 
Date Detail:
Created Date:  2011-10-12     Completed Date:  2012-02-14     Revised Date:  2014-09-24    
Medline Journal Info:
Nlm Unique ID:  101165286     Medline TA:  Crit Pathw Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  128-33     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Acute Coronary Syndrome / complications,  diagnosis*,  epidemiology
Aged
Cardiac Imaging Techniques*
Chest Pain / complications,  diagnosis*
Confidence Intervals
Coronary Care Units
Cross-Sectional Studies
Diagnosis, Differential
Electrocardiography
Exercise Test / methods*
Female
Follow-Up Studies
Humans
Incidence
Male
Middle Aged
Odds Ratio
Prognosis
Reproducibility of Results
Retrospective Studies
Risk Assessment / methods*
Risk Factors
Grant Support
ID/Acronym/Agency:
T-32 HL087730/HL/NHLBI NIH HHS; T32 HL087730/HL/NHLBI NIH HHS; T32 HL087730-03/HL/NHLBI NIH HHS
Comments/Corrections

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