Multicenter observational study on the reliability of the HEART score
Nicola Parenti1, Giuseppe Lippi2, Maria Letizia Bacchi Reggiani3
1Emergency Department, University Hospital of Modena, Modena, Italy.
Insights
The HEART score shows good reliability for identifying acute coronary syndrome risk in chest pain patients. However, the history component needs improvement for objective assessment.
Area of Science:
- Emergency Medicine
- Cardiology
- Clinical Assessment
Background:
- Acute coronary syndrome (ACS) risk stratification is crucial for chest pain patients.
- The History, Electrocardiogram, Age, Risk Factors, and Troponin (HEART) score is a proposed tool for rapid ACS risk identification.
- Assessing the reliability of clinical tools among healthcare professionals is essential for their effective implementation.
Purpose of the Study:
- To evaluate the inter-rater reliability of the HEART score among Italian emergency physicians.
- To determine the agreement levels for different risk categories and individual components of the HEART score.
Main Methods:
- A study involving 20 emergency physicians who independently scored 53 clinical scenarios of chest pain patients.
- Scenarios were derived from medical records and randomly administered after physicians completed a HEART score training course.
- Inter-rater reliability was assessed using kappa statistics.
Main Results:
- Overall good inter-rater reliability for the HEART score was observed (κ = 0.63).
- Good agreement was found for high-risk (7-10) and low-risk (0-3) categories (κ = 0.60-0.73).
- Moderate agreement was noted for the intermediate-risk category (4-6) (κ = 0.51), with lower agreement for history (κ = 0.37) and electrocardiogram (κ = 0.42) components.
Conclusions:
- The HEART score demonstrates good inter-rater reliability, especially for classifying patients into high and low-risk groups.
- The reliability of the history component of the HEART score requires enhancement for more objective risk assessment.
- Further standardization may improve the consistency of HEART score application in emergency departments.
Objective:
To rapidly and safely identify the risk of developing acute coronary syndrome in patients with chest pain who present to the emergency department, the clinical use of the History, Electrocardiogram, Age, Risk Factors, and Troponin (HEART) scoring has recently been proposed. This study aimed to assess the inter-rater reliability of the HEART score calculated by a large number of Italian emergency physicians.
Methods:
The study was conducted in three academic emergency departments using clinical scenarios obtained from medical records of patients with chest pain. Twenty physicians, who took the HEART score course, independently assigned a score to different clinical scenarios, which were randomly administered to the participants, and data were collected and recorded in a spreadsheet by an independent investigator who was blinded to the study's aim.
Results:
After applying the exclusion criteria, 53 scenarios were finally included in the analysis. The general inter-rater reliability was good (kappa statistics [κ], 0.63; 95% confidence interval, 0.57 to 0.70), and a good inter-rater agreement for the high- and low-risk classes (HEART score, 7 to 10 and 0 to 3, respectively; κ, 0.60 to 0.73) was observed, whereas a moderate agreement was found for the intermediate-risk class (HEART score, 4 to 6; κ, 0.51). Among the different items of the HEART score, history and electrocardiogram had the worse agreement (κ, 0.37 and 0.42, respectively).
Conclusion:
The HEART score had good inter-rater reliability, particularly among the high- and low-risk classes. The modest agreement for history suggests that major improvements are needed for objectively assessing this component.
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