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Assessing risk of major adverse cardiac event among COVID-19 patients using HEART score

Afrah Abdul Wahid Ali1, Quincy Tran2,3, Neeraja Murali2

  • 1Department of Emergency Medicine, University of Maryland School of Medicine, 110 S Paca Street, 6th Floor, Suite 200, Baltimore, MD, 21201, USA. aaali@som.umaryland.edu.

Internal and Emergency Medicine
|July 25, 2023
PubMed

Insights

The HEART score effectively predicts major adverse cardiac events (MACE) in chest pain patients with COVID-19, similar to those without the virus. This score remains a valuable tool for emergency department evaluations.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Emergency Medicine

Background:

  • Coronavirus disease 2019 (COVID-19) is linked to cardiovascular complications.
  • The applicability of the HEART score for chest pain patients with COVID-19 requires investigation.

Purpose of the Study:

  • To assess the impact of COVID-19 co-infection on the HEART score's ability to predict 30-day major adverse cardiac events (MACE).
  • To evaluate the HEART score's predictive performance in emergency department patients with chest pain and COVID-19.

Main Methods:

  • A multicenter, retrospective observational study analyzing 46,210 adult patients with chest pain across 13 emergency departments.
  • Patients were evaluated using the HEART score, with 30-day MACE (acute myocardial infarction, PCI, CABG, death) as the primary outcome.
  • Receiver operating characteristic (ROC) curves assessed the HEART score's sensitivity and specificity in COVID-19 co-infected patients.

Main Results:

  • Out of 46,210 patients, 327 (0.7%) had COVID-19. COVID-19 patients had a slightly higher mean HEART score (3.3 vs. 3.1).
  • The rate of 30-day MACE was similar between COVID-19 positive (0.6%) and negative (1.1%) groups.
  • The HEART score demonstrated strong predictive capability for MACE in COVID-19 patients (AUROC 0.99), comparable to the control group (AUROC 0.78).

Conclusions:

  • The HEART score retains its predictive value for 30-day MACE in emergency department patients with chest pain and concurrent COVID-19 infection.
  • Further research with larger COVID-19 cohorts is needed to validate these findings.
  • The HEART score remains a relevant tool for risk stratification in chest pain presentations, even with COVID-19 co-infection.

Keywords:
COVID-19CardiologyChest painEmergency medicineHEART score

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