Key result
A HEART score ≥4 independently predicted major adverse cardiovascular events at 12 months compared to a score of 0-3 (20.4% vs 3.1%; OR 7.456, 95% CI 2.175-25.56; P=0.001).
Why the study?
Does an intermediate-high HEART score (≥4) predict major adverse cardiovascular events in patients admitted with chest pain?
Cohort (n=299)
No
Does an intermediate-high HEART score (≥4) predict major adverse cardiovascular events in patients admitted with chest pain?
Odds Ratio: 7.456 (95% CI 2.175–25.56)
Absolute Event Rate: 20.4% vs 3.1%
p-value: p=0.001
A HEART score of ≥4 strongly predicts 12-month MACE and the need for inpatient revascularization among patients admitted with chest pain in a US inner-city hospital.
May aid risk stratification in CAD; extends observational data but leaves open prospective validation.
BACKGROUND: Chest pain is one of the most common presentations to a hospital, and appropriate triaging of these patients can be challenging. The HEART score has been used for such purposes in some countries and only a few validation studies from the USA are available. We aim to determine the utility of the HEART score in patients presenting with chest pain to an inner-city hospital in the USA. PATIENTS AND METHODS: We retrospectively screened 417 consecutive patients admitted with chest pain to the observation/telemetry units at Einstein Medical Center Philadelphia. After applying inclusion and exclusion criteria, 299 patients were included in the analysis. Patients were divided into low-risk (0-3) and intermediate-high (≥4)-risk HEART score groups. Baseline characteristics, thrombolysis in myocardial infarction score, need for revascularization during index hospitalization, and major adverse cardiovascular events (MACE) at 6 weeks and 12 months were recorded. RESULTS: There were 98 and 201 patients in the low-score group and intermediate-high-score group, respectively. Compared with the low-score group, patients in the intermediate-high-risk group had a higher incidence of revascularization during the index hospital stay (16.4 vs. 0%; P=0.001), longer hospital stay, higher MACE at 6 weeks (9.5 vs. 0%) and 12 months (20.4 vs. 3.1%), and higher cardiac readmissions. HEART score of at least 4 independently predicted MACE at 12 months (odds ratio 7.456, 95% confidence interval: 2.175-25.56; P=0.001) after adjusting for other risk factors in regression analysis. CONCLUSION: HEART score of at least 4 was predictive of worse outcomes in patients with chest pain in an inner-city USA hospital. If validated in multicenter prospective studies, the HEART score could potentially be useful in risk-stratifying patients presenting with chest pain in the USA and could impact clinical decision-making.
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Patnaik et al. (2017) conducted a cohort in Chest pain (n=299). HEART score ≥4 (intermediate-high risk) vs. HEART score 0-3 (low risk) was evaluated on Major adverse cardiovascular events (MACE) at 12 months (OR 7.456, 95% CI 2.175-25.56, p=0.001). A HEART score ≥4 independently predicted major adverse cardiovascular events at 12 months compared to a score of 0-3 (20.4% vs 3.1%; OR 7.456, 95% CI 2.175-25.56; P=0.001).
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