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Not all HEART scores are created equal: identifying "low-risk" patients at higher risk

Kimon L H Ioannides1, Benjamin C Sun2, Aileen S Baecker3

  • 1National Clinician Scholars Program Department of Emergency Medicine University of California, Los Angeles Los Angeles California USA.

Journal of the American College of Emergency Physicians Open
|January 4, 2021
PubMed

Insights

Even with a low HEART score, certain factors like elevated troponin or ECG changes increase the risk of acute myocardial infarction or death. This highlights the need for careful evaluation in suspected acute coronary syndrome cases.

Area of Science:

  • Cardiology
  • Emergency Medicine
  • Clinical Risk Stratification

Background:

  • The HEART score (History, ECG, Age, Risk Factors, Troponin) is used to assess patients with suspected acute coronary syndrome (ACS).
  • Identifying "low-risk" subgroups within the HEART score (0-5 points) who may still be at elevated risk is crucial for patient management.

Purpose of the Study:

  • To identify subgroups of "low-risk" HEART score patients at elevated risk of acute myocardial infarction (AMI) or death within 30 days.
  • To analyze the incremental risk associated with each component of the HEART score in low-risk patients.

Main Methods:

  • Secondary analysis of prospective emergency department (ED) encounters for suspected ACS.
  • Inclusion of patients with low-risk HEART scores (0-5 points).
  • Logistic regression was used to analyze the risk contribution of each of the five HEART score components.

Main Results:

  • Out of 30,971 encounters, 135 (0.44%) experienced AMI or death.
  • Risk of AMI or death increased with higher points in most HEART score components (History, ECG, Age, Risk Factors).
  • The troponin component showed the highest risk increase with 1 point (2.7%), and ECG also demonstrated significant risk increases (3.5 odds ratio for 2 points vs 0).

Conclusions:

  • In "low-risk" suspected ACS encounters, higher points in HEART score components are associated with small increases in AMI or death risk.
  • Troponin and ECG components were identified as having the largest impact on risk increases within the low-risk group.
  • These findings emphasize the importance of considering individual component contributions even in patients with overall low HEART scores.
Abstract

Keywords:
HEART scoreacute coronary syndromechest paincoronary artery diseasemyocardial infarction

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