Short- and Long-Term Prognostic Utility of the HEART Score in Patients Evaluated in the Emergency Department for Possible Acute Coronary Syndrome
Jain T, Nowak R, Hudson M, Frisoli T, Jacobsen G, and McCord J. Short- and long-term prognostic utility of the HEART score in patients evaluated in the emergency department for possible acute coronary syndrome. Crit Pathw Cardiol 2016; 15(2):40-45.
Crit Pathw Cardiol
INTRODUCTION: The HEART score is a risk-stratification tool that was developed and validated for patients evaluated for possible acute coronary syndrome (ACS) in the emergency department (ED). We sought to determine the short-term and long-term prognostic utility of the HEART score.
METHODS: A retrospective single-center analysis of 947 patients evaluated for possible ACS in the ED in 1999 was conducted. Patients were followed for major adverse cardiac events (MACEs) at 30 days: death, acute myocardial infarction, or revascularization procedure. All-cause mortality was assessed at 5 years. The HEART score was compared with the Thrombolysis in Myocardial Infarction (TIMI) score.
RESULTS: At 30 days, 14% (135/947) of patients had an MACE: 48 deaths (5%), 84 acute myocardial infarctions (9%), and 48 (5%) revascularization procedures. The MACE rate in patients with HEART score ≤3 was 0.6% (1/175) involving a revascularization procedure, 9.5% (53/557) in patients with HEART score between 4 and 6, and 38% (81/215) with HEART score ≥7. The C-statistic for the HEART score was 0.82 and 0.68 for the TIMI score for predicting 30-day MACE (P < 0.05). Patients with HEART score ≤3 had lower 5-year mortality rate compared with those with TIMI score of 0 (10.6% vs. 20.5%, P = 0.02).
CONCLUSIONS: The HEART score is a valuable risk-stratification tool in predicting not only short-term MACE but also long-term mortality in patients evaluated for possible ACS in the ED. The HEART score had a superior prognostic value compared with the TIMI score.
Medical Subject Headings
Acute Coronary Syndrome; Aged; Cause of Death; Electrocardiography; Emergency Service, Hospital; Female; Follow-Up Studies; Humans; Incidence; Male; Michigan; Middle Aged; Prognosis; Retrospective Studies; Risk Assessment; Risk Factors; Survival Rate; Time Factors