Use of the HEAR Score for 30-Day Risk-Stratification in Emergency Department Patients

Area of Science:

• Cardiology
• Emergency Medicine
• Clinical Risk Stratification

Background:

• 2021 ACC/AHA guidelines recommend risk scores like HEAR for chest pain risk stratification.
• Limited data exist on integrating HEAR scores with high-sensitivity cardiac troponin T (hs-cTnT) assays.
• Accurate short-term risk assessment is crucial for emergency department patients with chest pain.

Purpose of the Study:

• To evaluate the utility of HEAR scores in conjunction with hs-cTnT for 30-day major adverse cardiovascular event (MACE) risk stratification.
• To determine if HEAR scores improve risk prediction beyond hs-cTnT levels in emergency department patients.
• To assess the prognostic value of HEAR scores across different hs-cTnT measurement ranges.

Main Methods:

• Retrospective, observational, multicenter US cohort study.
• Included emergency department patients without STEMI, with at least one hs-cTnT measurement.
• HEAR scores (0-8) and 30-day MACE were assessed.

Main Results:

• HEAR scores showed limited association with 30-day MACE in adjusted analyses.
• Quantifiable hs-cTnT (LoQ-99th percentile) was associated with increased 30-day MACE risk, irrespective of HEAR score.
• Serial hs-cTnT <99th percentile indicated low risk across all HEAR score strata; higher HEAR scores did not predict long-term events.

Conclusions:

• HEAR scores have limited prognostic value when baseline hs-cTnT is below limit of quantitation or above the 99th percentile.
• A significant risk for 30-day MACE exists in patients with quantifiable hs-cTnT within the reference range, even with low HEAR scores.
• HEAR scores may overestimate risk when serial hs-cTnT measurements remain below the 99th percentile.