Retrospective Internal Validation of the HEART Score as an Objective Predictor of a Major Adverse Cardiac Event

Abstract

Background: The goal of the HEART score is to provide emergency physicians with a superior risk stratification tool in the assessment of the acute chest pain patient. It is difficult to determine the severity of the chest pain complaint and many regional emergency physicians have expressed a desire to have a validated, easy, reliable, and quick predictor that will allow them to safely discharge chest pain patients with an acceptably low risk of MACE occurring in the following 6 weeks. Objectives: This retrospective study is an internal validation in the Scottsdale, Arizona region of the HEART score as an objective predictor that a major adverse cardiac event (MACE) has a 1.7% or lower chance of occurring within six weeks in the adult patient population presenting to and discharged from the emergency department with acute chest pain. Methods: This study included 117 patients available for review. 53 could not be contacted for follow-up, yielding 64 patients for analysis. Eligible patients were considered those with an initial chief complaint of “chest pain” upon presentation, who met the “low risk” classification of the HEART score, and who were appropriately discharged (NOT admitted) from any of the Honor Health Scottsdale Hospitals. Results: Less than 1.7% of discharged patients (1/64, 1.57%) who met the HEART score criteria for “lowrisk” patients had a MACE occurrence in the 6 weeks following discharge. Conclusions: The HEART score is internally validated as an objective predictor of no MACE occurring in chest pain patients presenting to these emergency departments.