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HEART Score and Stress Test Emergency Department Bayesian Decision Scheme: Results from the Acute Care Diagnostic

Naureen Farook1, L Cochon2, A D Bode3

  • 1Department of Internal Medicine/Emergency Medicine, Henry Ford Health System, Detroit, Michigan.

The Journal of Emergency Medicine
|February 12, 2018
PubMed

Insights

This study compared stress echocardiograms (ECHO) and exercise treadmill tests (ETT) for predicting major adverse cardiac events (MACE) in low- to intermediate-risk patients. Stress ECHO showed a slight superiority over ETT in ruling out MACE.

Area of Science:

  • Cardiology
  • Medical Diagnostics
  • Bayesian Statistics

Background:

  • Accurate risk stratification for major adverse cardiac events (MACE) is crucial for emergency physicians.
  • Bayesian nomograms have not been previously investigated for risk stratification in cardiovascular patients with low- to intermediate-risk profiles.

Purpose of the Study:

  • To develop a comparative diagnostic model using Bayesian statistics to assess the post-test risk of MACE.
  • To compare the diagnostic accuracy of exercise treadmill testing (ETT) and stress echocardiography (ECHO).
  • To utilize the HEART (history, electrocardiogram, age, risk factors, and troponin) score for pretest probability estimation.

Main Methods:

  • Stratification of patients based on HEART scores for MACE prediction.
  • Calculation of pooled sensitivity and specificity for ETT and ECHO to determine likelihood ratios (LR).
  • Application of Bayesian nomograms with HEART scores and LRs to compute post-test probabilities.

Main Results:

  • Negative likelihood ratios (LR-) for ECHO (0.15) were more effective in ruling out MACE than ETT (0.27).
  • For low-risk patients, ECHO yielded a post-test probability of 0.26% (LR-) compared to ETT's 0.46% (LR-).
  • For intermediate-risk patients, ECHO yielded a post-test probability of 2.49% (LR-) compared to ETT's 4.48% (LR-).

Conclusions:

  • Bayesian analysis indicates stress ECHO is slightly superior to ETT in ruling out MACE for low- and intermediate-risk patients.
  • The negative LR of ECHO was statistically significant in excluding MACE.
  • This model provides a valuable tool for risk stratification in cardiovascular patient assessment.
Abstract

Keywords:
ECHOHEART scoreMACEexercise stress test

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