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Elevated Major Adverse Cardiac Event (MACE) Risk With a HEART Score of 3: A Single-Site Retrospective Validation

David R Janese1, Marshall Byun-Andersen1, Danielle Handrop1

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Summary

The HEART pathway

Keywords:
chest painclinical decision-makingheart scoremyocardial infarctionrisk-benefit assessmenttroponin

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Area of Science:

  • Emergency Medicine
  • Cardiology
  • Clinical Decision Support

Background:

  • The HEART pathway is a standard tool for assessing chest pain patients in the emergency department (ED).
  • A HEART score of 3 or less is typically considered low risk, guiding safe patient discharge.
  • Evaluating the HEART pathway's performance in diverse settings is crucial for refining risk stratification.

Purpose of the Study:

  • To assess the HEART pathway's accuracy in an urban academic ED.
  • To determine the rate of major adverse cardiac events (MACE) in patients with a HEART score of 3.
  • To compare observed MACE rates with the established low-risk threshold.

Main Methods:

  • Retrospective chart review of 1,284 chest pain visits.
  • Data collection included HEART scores, demographics, and 90-day MACE outcomes.
  • Non-parametric statistical methods were used for analysis.

Main Results:

  • Overall, 6.2% of patients experienced MACE within 90 days.
  • Patients with a HEART score of 3 or less had a 4.4% MACE rate.
  • HEART score positively correlated with MACE (ρ = 0.223, p < 0.001).

Conclusions:

  • A HEART score of 3 is associated with a MACE rate exceeding the 2% low-risk threshold.
  • Clinicians should exercise caution when discharging patients with a HEART score of 3.
  • Further research is needed to optimize the interpretation of the HEART score at critical thresholds.