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Prehospital Modified HEART Score Predictive of 30-Day Adverse Cardiac Events
Jason P Stopyra1, William S Harper1, Tyson J Higgins2
11Wake Forest School of Medicine,Winston-Salem,North CarolinaUSA.
Insights
A prehospital modified HEART score effectively identifies low-risk patients with chest pain, showing a high negative predictive value for major adverse cardiac events within 30 days. This tool aids in risk stratification for emergency medical services.
Area of Science:
- Emergency Medicine
- Cardiology
- Clinical Decision Support
Background:
- The History, Electrocardiogram (ECG), Age, Risk Factors, and Troponin (HEART) score is validated for emergency department (ED) use in stratifying acute chest pain patients.
- Its utility in the prehospital setting for undifferentiated chest pain remains unevaluated.
Purpose of the Study:
- To evaluate a prehospital modified HEART score's ability to predict major adverse cardiac events (MACE) in patients with chest pain.
- To assess the score's sensitivity and negative predictive values (NPVs) for 30-day MACE.
Main Methods:
- Retrospective cohort study of 794 patients with chest pain transported by Emergency Medical Service (EMS) agencies.
- Exclusion of patients with STEMI, inter-facility transfers, and those lacking prehospital ECG or ED troponin.
- Calculation of modified HEART scores and 30-day MACE determination (death, MI, revascularization).
Main Results:
- 10.7% of patients experienced 30-day MACE.
- The modified HEART score identified 33.2% of patients as low risk, with only 1.9% experiencing MACE.
- High sensitivity (94.1%) and NPV (98.1%) for 30-day MACE were observed.
Conclusions:
- Prehospital modified HEART scores demonstrate a high NPV for predicting 30-day MACE.
- Prospective studies applying this decision aid in prehospital settings are recommended.
Abstract:
Introduction The History, Electrocardiogram (ECG), Age, Risk Factors, and Troponin (HEART) score is a decision aid designed to risk stratify emergency department (ED) patients with acute chest pain. It has been validated for ED use, but it has yet to be evaluated in a prehospital setting. Hypothesis A prehospital modified HEART score can predict major adverse cardiac events (MACE) among undifferentiated chest pain patients transported to the ED.
Methods:
A retrospective cohort study of patients with chest pain transported by two county-based Emergency Medical Service (EMS) agencies to a tertiary care center was conducted. Adults without ST-elevation myocardial infarction (STEMI) were included. Inter-facility transfers and those without a prehospital 12-lead ECG or an ED troponin measurement were excluded. Modified HEART scores were calculated by study investigators using a standardized data collection tool for each patient. All MACE (death, myocardial infarction [MI], or coronary revascularization) were determined by record review at 30 days. The sensitivity and negative predictive values (NPVs) for MACE at 30 days were calculated.
Results:
Over the study period, 794 patients met inclusion criteria. A MACE at 30 days was present in 10.7% (85/794) of patients with 12 deaths (1.5%), 66 MIs (8.3%), and 12 coronary revascularizations without MI (1.5%). The modified HEART score identified 33.2% (264/794) of patients as low risk. Among low-risk patients, 1.9% (5/264) had MACE (two MIs and three revascularizations without MI). The sensitivity and NPV for 30-day MACE was 94.1% (95% CI, 86.8-98.1) and 98.1% (95% CI, 95.6-99.4), respectively.
Conclusions:
Prehospital modified HEART scores have a high NPV for MACE at 30 days. A study in which prehospital providers prospectively apply this decision aid is warranted. Stopyra JP , Harper WS , Higgins TJ , Prokesova JV , Winslow JE , Nelson RD , Alson RL , Davis CA , Russell GB , Miller CD , Mahler SA . Prehospital modified HEART score predictive of 30-day adverse cardiac events. Prehosp Disaster Med. 2018;33(1):58-62.
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