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Effectiveness of Modified HEART Score in Predicting Major Adverse Cardiac Events

Sultan Tuna Akgol Gur1, Meryem Betos Kocak2, Abdullah Osman Kocak1

  • 1Department of Emergency Medicine, Ataturk University School of Medicine, Erzurum, Turkey.

The Eurasian Journal of Medicine
|March 15, 2021
PubMed

Insights

The modified HEART (mHEART) score, incorporating visual analog scale (VAS) pain severity, better identifies patients at low risk for major adverse cardiac events (MACE) than the standard HEART score. This improves chest pain assessment in emergency settings.

Area of Science:

  • Emergency Medicine
  • Cardiology
  • Clinical Decision Support

Background:

  • Chest pain is a common emergency department presentation requiring accurate risk stratification.
  • Existing scoring systems, like the HEART score, aid in decision-making but can be improved.
  • Visual analog scale (VAS) for pain severity is a readily available patient-reported outcome.

Purpose of the Study:

  • To modify the HEART score by incorporating the VAS pain severity.
  • To evaluate the performance of the modified HEART (mHEART) score in predicting major adverse cardiac events (MACE).

Main Methods:

  • Retrospective analysis of 293 patients presenting with chest pain.
  • Calculation of HEART score and a modified HEART (mHEART) score, adding a point for VAS ≥7.
  • Comparison of mHEART and HEART scores for predicting MACE within 30 days.

Main Results:

  • The mHEART score demonstrated improved predictive accuracy compared to the HEART score.
  • Fewer patients incorrectly classified as low-risk for MACE using the mHEART score (1/246) versus the HEART score (6/251).
  • 26.3% of patients had VAS scores ≥7, indicating significant pain severity in a notable subgroup.

Conclusions:

  • Incorporating VAS pain severity into the HEART score enhances its ability to identify low-risk chest pain patients.
  • The mHEART score offers a more refined tool for emergency physicians managing chest pain presentations.
  • Further validation studies are recommended to support the clinical adoption of the mHEART score.
Abstract

Keywords:
Heart scoreacute coronary syndromechest pain

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