Performance of a simplified HEART score and HEART-GP score for evaluating chest pain in urgent primary care

Area of Science:

• Cardiology
• Primary Care Medicine
• Diagnostic Accuracy

Background:

• Chest pain is a frequent symptom in urgent primary care settings, presenting diagnostic challenges.
• Differentiating between urgent and non-urgent causes of chest pain is crucial for timely intervention.
• Modified HEART score versions, omitting troponin (simplified HEART) or incorporating physician's 'sense of alarm' (HEART-GP), show potential for risk stratification.

Purpose of the Study:

• To evaluate the diagnostic accuracy of modified HEART score versions in primary care for chest pain patients.
• To assess the utility of the simplified HEART score and the HEART-GP score in risk stratification.
• To compare the performance of these modified scores against traditional clinical judgment in identifying major adverse cardiac events (MACEs).

Main Methods:

• Retrospective observational cohort study of 664 patients presenting with chest pain at an out-of-hours primary care facility.
• Six-week follow-up for major adverse cardiac events (MACEs).
• Analysis of diagnostic accuracy, including positive predictive value (PPV) and negative predictive value (NPV) for simplified HEART and HEART-GP scores.

Main Results:

• The HEART-GP score demonstrated higher diagnostic accuracy (C-statistic 0.90) compared to the simplified HEART score (C-statistic 0.86).
• Optimal diagnostic thresholds identified were simplified HEART score ≥2 (NPV 99.7%) and HEART-GP score ≥3 (NPV 99.7%).
• Utilizing these scores could potentially reduce unnecessary referrals while maintaining high sensitivity for MACE detection.

Conclusions:

• Modified HEART scores, particularly HEART-GP incorporating physician's 'sense of alarm', are valuable tools for chest pain risk stratification in primary care.
• These scores are effective in settings lacking routine troponin assay access.
• Further validation studies are recommended to confirm the clinical utility and generalizability of these modified HEART scores.