Performance of the modified HEART score in an Asian population
Shanaz Matthew Sajeed1,2, Michael P De Dios3, Dan Wei Jun Ong4
1Department of Emergency Medicine and Department of Intensive Care Medicine, Ng Teng Fong General Hospital, 1 Jurong East Street 21, Singapore, 609606, Singapore. shanazsajeed@gmail.com.
Insights
The modified HEART score effectively identifies low-risk patients with chest pain for early discharge. This tool aids in risk stratification for acute coronary syndrome in diverse Asian populations.
Area of Science:
- Cardiology
- Emergency Medicine
- Clinical Risk Stratification
Background:
- Chest pain is a common emergency department presentation requiring accurate risk stratification.
- The original HEART score used conventional troponins; this study evaluates a modified version.
- Assessing the modified HEART score's utility in an ethnically diverse Asian population is crucial.
Purpose of the Study:
- To assess the modified HEART score's utility with highly sensitive troponins in an Asian population.
- To determine if the modified HEART score corroborates findings from previous Chinese studies.
- To evaluate the modified HEART score's effectiveness in risk stratifying patients with undifferentiated chest pain.
Main Methods:
- Analysis of clinical data from 413 patients presenting to the ED with chest pain.
- Evaluation of the modified HEART score's predictive value for major adverse cardiac events (MACE).
- Stratification of patients into low, intermediate, and high-risk groups based on MACE.
Main Results:
- A total of 49 patients (11.9%) experienced MACE.
- MACE rates were 1.4% (low-risk), 5.2% (intermediate-risk), and 33.3% (high-risk).
- The score identified distinct risk groups, aiding in clinical decision-making.
Conclusions:
- The modified HEART score is an effective risk stratification tool in a diverse Asian population.
- It accurately identifies low-risk patients suitable for early emergency department discharge.
- This tool can improve the management of patients presenting with chest pain.
Introduction:
Chest pain is the most common potentially life-threatening presentation to the emergency department (ED). Furthermore, the identification of acute coronary syndrome (ACS) including its risk stratification and subsequent disposition can be challenging. The original HEART score was derived as a predictive tool to risk stratify patients presenting with undifferentiated chest pain (CP) and aid physician decision-making. However, it utilized conventional troponins as its cardiac biomarker component. Our study aims to assess the utility of the modified HEART score with highly sensitive troponins in an Asian setting with mixed ethnicity to determine if it corroborates the findings of another recent Chinese study by Chun-Peng et al. (Journal of Geriatric Cardiology 13:64-69, 2016).
Methods:
Clinical data from 413 patients presenting to the ED for evaluation of chest pain were analyzed. The predictive value of the modified HEART score for determining major adverse cardiac events (MACE) was then evaluated.
Results:
A total of 49 patients (11.9%) had a MACE: 31 patients (7.5%) underwent PCI and 1 patient (0.2%) underwent CABG. There were 17 (4.1%) deaths. Three risk groups were elucidated based on MACE. In the low-risk group (0-2), there were 72 patients (17.4%), with a MACE rate of 1.4%. In the intermediate-risk group (3-5), there were 233 patients (56.4%), with a MACE rate of 5.2%. In the high-risk group (6-10), there were 108 patients (26.2%), with a MACE rate of 33.3%.
Conclusion:
The modified HEART score is an effective risk stratification tool in an ethnically diverse Asian population. Furthermore, it identifies low-risk patients who are candidates for early discharge from a local emergency department.
