Key result
The modified HEART score, which includes a pain severity parameter, reduced the rate of missed major adverse cardiac events in low-risk patients to 0.4% compared to 2.3% with the standard HEART score.
Why the study?
Deciding whether to discharge patients presenting with chest pain is a key challenge for emergency physicians, prompting the development of scoring systems to aid decision-making.
Does the modified HEART score (mHEART) improve the prediction of major adverse cardiac events compared to the standard HEART score in adult patients presenting to the emergency department with chest pain?
Cross-Sectional (n=293)
No
Does the modified HEART score (mHEART) improve the prediction of major adverse cardiac events compared to the standard HEART score in adult patients presenting to the emergency department with chest pain?
Answers are grounded in this paper and cite their sources.
Adding a visual analog scale (VAS) pain score to the standard HEART score significantly improves its negative predictive value for ruling out major adverse cardiac events in emergency department patients with chest pain.
OBJECTIVE: The most important problem for emergency physicians in patients presenting with chest pain is deciding whether to discharge the patient or not. Therefore, many scoring systems have been developed to help with this decision making process. We aim to achieve a modified HEART value by combining the VAS value with the HEART score. MATERIALS AND METHODS: Data were collected on age, sex, duration of the symptoms, pain severity using a 10-point visual analog scale (VAS), and the presence of a major adverse cardiac event (MACE). The HEART score was calculated and modified (mHEART) by adding 1 point to the total HEART score for a VAS score of ≥7. RESULTS: During the study period, 4781 patients were admitted, and 293 participants were analyzed. Of the patients, 34(11.6%) experienced MACE within a month after the encounter. The mean VAS scores were 5.65±1.44. However, 77(26.3%) patients had VAS scores ≥7. Taking 3 as the threshold, 42(14.3%) patients had HEART scores of 4 and above, where 47(16.0%) had mHEART scores ≥4. The mHEART scoring demonstrated better test indicators than the HEART score. According to the HEART score, 6(2.3%) of the 251 patients predicted as negative would develop MACE, but this number decreased to 1(0.4%) in 246 using the mHEART score. CONCLUSION: Although the HEART score performs reasonably well in discriminating patients who are MACE negative, it is possible to further improve the score by adding the VAS item. After validation by other studies, we would suggest modifying the HEART score by including the VAS item.
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Gür et al. (2021) conducted a cross-sectional in Chest pain (n=293). Modified HEART score (mHEART) vs. HEART score was evaluated on Prediction of Major Adverse Cardiac Events (MACE) at 30 days (AUC 0.987, 95% CI 0.976-0.999, p=<0.001). The modified HEART score, which includes a pain severity parameter, reduced the rate of missed major adverse cardiac events in low-risk patients to 0.4% compared to 2.3% with the standard HEART score.
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