Why the study?
Does an adjusted HEART score model improve risk stratification for major adverse cardiac events compared to the original HEART score in chest pain patients at the emergency department?
Does an adjusted HEART score model improve risk stratification for major adverse cardiac events compared to the original HEART score in chest pain patients at the emergency department?
Multivariable statistical analyses support the previously chosen weights of the original HEART score, confirming its clinical usefulness in daily practice for risk stratifying chest pain patients.
Original HEART score remains preferable for ED chest pain stratification; confirms its weights in observational data but leaves open prospective validation.
OBJECTIVES: Risk stratification for chest pain patients at the emergency department is recommended in several guidelines. The history, ECG, age, risk factors, and troponin (HEART) score is based on medical literature and expert opinion to estimate the risk of a major adverse cardiac event. We aimed to assess the predictive effects of the 5 HEART components and to compare performances of the original HEART score and a model based on regression analysis. METHODS: We analyzed prospectively collected data from 2388 patients, of whom 407 (17%) had a major adverse cardiac event within 6 weeks (acute myocardial infarction, percutaneous coronary intervention, coronary artery bypass graft, significant stenosis with conservative treatment and death due to any cause). RESULTS: Univariate regression analysis showed the same ordering of predictive effects as used in the HEART score. Based on multivariable logistic regression analysis, an adjusted score showed slightly better calibration and discrimination (c statistic HEART, 0.83, HEART-adj, 0.85). In comparison to HEART, HEART-adj proved in a decision curve analysis clinically useful for decision thresholds over 25%. Nevertheless, the original HEART classified patients better than HEART-adj (net reclassification improvement = 14.1%). CONCLUSION: The previously chosen weights of the 5 elements of the HEART score are supported by multivariable statistical analyses, although some improvement in calibration and discrimination is possible by adapting the score. The gain in clinical usefulness is relatively small and supports the use of either the original or adjusted HEART score in daily practice.
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Backus et al. (2016) studied this question.
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