Key result
The HEART score demonstrated good general inter-rater reliability (kappa 0.63) among emergency physicians evaluating chest pain scenarios, though agreement was modest for the history component.
Why the study?
The HEART score was recently proposed to rapidly and safely identify the risk of developing ACS in ED patients with chest pain, but its inter-rater reliability among emergency physicians required assessment.
Observational (n=53)
Investigator blinded
Random administration of scenarios
Yes
Effect estimate: kappa 0.63 (95% CI 0.57 to 0.70)
The HEART score demonstrates good inter-rater reliability among emergency physicians for identifying high- and low-risk chest pain patients, though agreement on the history component remains modest.
Supports HEART score reliability for ED chest pain triage; leaves open history standardization in prospective validation.
OBJECTIVE: To rapidly and safely identify the risk of developing acute coronary syndrome in patients with chest pain who present to the emergency department, the clinical use of the History, Electrocardiogram, Age, Risk Factors, and Troponin (HEART) scoring has recently been proposed. This study aimed to assess the inter-rater reliability of the HEART score calculated by a large number of Italian emergency physicians. METHODS: The study was conducted in three academic emergency departments using clinical scenarios obtained from medical records of patients with chest pain. Twenty physicians, who took the HEART score course, independently assigned a score to different clinical scenarios, which were randomly administered to the participants, and data were collected and recorded in a spreadsheet by an independent investigator who was blinded to the study's aim. RESULTS: After applying the exclusion criteria, 53 scenarios were finally included in the analysis. The general inter-rater reliability was good (kappa statistics [κ], 0.63; 95% confidence interval, 0.57 to 0.70), and a good inter-rater agreement for the high- and low-risk classes (HEART score, 7 to 10 and 0 to 3, respectively; κ, 0.60 to 0.73) was observed, whereas a moderate agreement was found for the intermediate-risk class (HEART score, 4 to 6; κ, 0.51). Among the different items of the HEART score, history and electrocardiogram had the worse agreement (κ, 0.37 and 0.42, respectively). CONCLUSION: The HEART score had good inter-rater reliability, particularly among the high- and low-risk classes. The modest agreement for history suggests that major improvements are needed for objectively assessing this component.
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Parenti et al. (2019) conducted an observational in Chest pain (n=53). HEART score was evaluated on Inter-rater agreement in the calculation of the HEART score (kappa 0.63, 95% CI 0.57 to 0.70). The HEART score demonstrated good general inter-rater reliability (kappa 0.63) among emergency physicians evaluating chest pain scenarios, though agreement was modest for the history component.
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