Related Experiment Video

Updated: May 17, 2026

Cutoff Value of Phase Angle by Bioelectrical Impedance Analysis at Admission as a Prognostic Factor in Patients with Acute Heart Failure
05:16

Cutoff Value of Phase Angle by Bioelectrical Impedance Analysis at Admission as a Prognostic Factor in Patients with Acute Heart Failure

Published on: June 10, 2025

Identifying patients for early discharge: performance of decision rules among patients with acute chest pain

Simon A Mahler1, Chadwick D Miller, Judd E Hollander

  • 1Wake Forest School of Medicine, Winston-Salem, NC, USA.

International Journal of Cardiology
|November 3, 2012
PubMed

Insights

The HEART score, combined with serial troponin tests, effectively identifies acute coronary syndrome patients for early discharge, demonstrating high sensitivity and improved clinical utility compared to other methods.

Area of Science:

  • Cardiology
  • Emergency Medicine
  • Diagnostic Accuracy

Background:

  • Acute chest pain evaluation relies on decision rules like the HEART score and North American Chest Pain Rule (NACPR) to facilitate early patient discharge.
  • These tools aim to reduce the need for extensive cardiac testing in low-risk individuals.

Purpose of the Study:

  • To compare the clinical utility of the HEART score and NACPR when integrated with serial troponin measurements for identifying acute chest pain patients suitable for early discharge.
  • To assess the sensitivity of these strategies for diagnosing acute coronary syndrome (ACS) within 30 days.

Main Methods:

  • A secondary analysis of 1005 patients from the Myeloperoxidase In the Diagnosis of Acute coronary syndromes Study (MIDAS) was performed.
  • Compared unstructured assessment, NACPR, and HEART score, each combined with 0 and 3-hour troponin levels, for early discharge eligibility and 30-day ACS sensitivity.

Main Results:

  • The HEART score identified 20% of patients for early discharge with 99% sensitivity for ACS.
  • The North American Chest Pain Rule identified 4.4% for early discharge with 100% sensitivity.
  • The HEART score demonstrated significant net reclassification improvement over unstructured assessment and NACPR.

Conclusions:

  • The HEART score, utilizing serial troponin measurements at 0 and 3 hours, effectively identifies a significant proportion of patients for early discharge.
  • This approach maintains a high sensitivity for detecting acute coronary syndrome, enhancing diagnostic efficiency in the emergency department.
Abstract

Keywords:
Acute coronary syndromeChest painClinical decision rulesRisk stratification

More Related Videos

Signal Acquisition, Score Interpretation, and Economics of a Non-Invasive Point-of-Care Test for Coronary Artery Disease06:16

Signal Acquisition, Score Interpretation, and Economics of a Non-Invasive Point-of-Care Test for Coronary Artery Disease

Published on: August 9, 2024

Left Anterior Descending Coronary Artery Ligation for Ischemia-Reperfusion Research: Model Improvement via Technical Modifications and Quality Control05:41

Left Anterior Descending Coronary Artery Ligation for Ischemia-Reperfusion Research: Model Improvement via Technical Modifications and Quality Control

Published on: December 16, 2022

Related Concept Videos

Acute Coronary Syndrome III: Diagnostic Studies01:30

Acute Coronary Syndrome III: Diagnostic Studies

Diagnosing acute coronary syndrome or ACS begins with a thorough patient history. Notable symptoms include central, crushing chest pain radiating to the left arm, neck, jaw, or back, along with shortness of breath, sweating (diaphoresis), nausea, vomiting, dizziness, and palpitations.It is crucial to note any history of cardiac illnesses and assess risk factors, including age, gender, smoking, hypertension, diabetes, hyperlipidemia, and a sedentary lifestyle.During physical examination, vital...
Acute Coronary Syndrome IV: Interprofessional Care01:28

Acute Coronary Syndrome IV: Interprofessional Care

IntroductionThe management of Acute Coronary Syndrome (ACS) aims to minimize myocardial damage, preserve myocardial function, and prevent complications.Initial ManagementInpatient management involves continuous cardiac monitoring, preferably in an ICU, focusing on blood pressure, serum sodium, potassium, and creatinine levels, and urine output. Ongoing pharmacologic management is crucial for stabilizing the patient.Supplemental Oxygen: Administer supplemental oxygen if oxygen saturation is...
Acute Coronary Syndrome V: Nursing Management01:26

Acute Coronary Syndrome V: Nursing Management

Nursing Assessment:Nursing management of acute coronary syndrome (ACS) involves taking the patient's history, focusing on primary complaints such as chest pain, dyspnea, and excessive sweating (diaphoresis), as well as other symptoms like back or jaw pain, nausea, vomiting, palpitations, dizziness, and fatigue. The nurse also reviews the patient's history of cardiac events, risk factors such as hypertension, diabetes, smoking, family history, and current medications.In the objective assessment,...
Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care01:29

Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care

Diagnosing Pulmonary EmbolismDiagnosing pulmonary embolism (PE) involves clinical assessment and advanced imaging tests. The preferred diagnostic tool is the spiral (helical) CT scan or CT angiography (CTA), which uses intravenous contrast media to visualize the pulmonary vasculature and identify emboli.A ventilation-perfusion (V/Q) scan is an alternative for patients unable to receive contrast media. This scan includes both perfusion and ventilation scanning. Perfusion scanning involves...
Imaging Studies for Cardiovascular System I:Echocardiography01:17

Imaging Studies for Cardiovascular System I:Echocardiography

Cardiac imaging studies encompass a wide range of noninvasive and minimally invasive techniques designed to visualize the heart's structure and function in detail. One such technique is echocardiography, which uses high-frequency ultrasound waves to produce detailed images of the heart, known as echocardiograms.
Indications: Echocardiography is utilized to diagnose heart failure, valve disorders, and myocardial infarction. It also assesses cardiac structures' size, shape, and motion, evaluates...
Angina V: Nursing Management01:20

Angina V: Nursing Management

Angina, a symptom of myocardial ischemia, requires a structured nursing management approach to ensure effective care and prevent complications like myocardial infarction. Comprehensive nursing care involves assessing, diagnosing, planning, implementing interventions, and evaluating outcomes, all tailored to the individual patient's needs.Patient AssessmentNursing assessment begins with a detailed subjective evaluation of symptoms, which typically include chest pain or pressure radiating to the...