Key result
The HEART2 score demonstrated better overall performance accuracy than the HEART score for predicting 30-day major adverse cardiac events in emergency department chest pain patients with previous cardiac imaging tests (AUC 0.74 vs 0.71).
Why the study?
The HEART score has been used to risk-stratify ED chest pain patients, but not particularly for patients with previous cardiac imaging tests performed.
Does the HEART2 score improve risk stratification for 30-day MACE compared to the traditional HEART score in ED chest pain patients with previous cardiac imaging?
Observational (n=9,419)
No
Does the HEART2 score improve risk stratification for 30-day MACE compared to the traditional HEART score in ED chest pain patients with previous cardiac imaging?
The HEART2 score, which incorporates previous cardiac imaging results, improves the accuracy of risk stratification for ED chest pain patients and could safely increase direct discharges by over 45% among those with prior imaging.
BACKGROUND: A significant number of chest pain patients had previous cardiac imaging tests (CIT) performed before being presented to the Emergency Department (ED). The HEART (history, electrocardiogram, age, risk factors, and troponin) score has been used to risk-stratify chest pain patients in the ED, but not particularly for patients with CIT performed. We aim to modify the current HEART score with the addition of most recent CIT findings (referred to as HEART2 score), to predict a 30-day major adverse cardiac event (MACE) among ED chest pain patients, compare the performance accuracy of using HEART versus HEART2 score for 30-day MACE outcome predictions, and further determine the value of HEART2 in a subset group of ED chest pain patients (i.e., ones with previous CIT). METHODS: This is a single-center observational study. We included chest pain patients with HEART scores calculated during their index ED visits. A modified HEART2 score was developed with the addition of CIT findings as one of the HEART2 components. Patients were divided into three groups, including low (≤ 3), moderate (4-6), and high-risk HEART/HEART2 scores (≥ 7). MACE occurrence of a patient with different risks of HEART and HEART2 scores and overall performance accuracy of HEART versus HEART2 score predicting MACE outcomes were compared. RESULTS: We included a total of 9419 chest pain patients at ED, among which one out of five patients (1874/9419) had previous CIT performed. Fewer (38.2%) of such patients had low-risk HEART scores in comparison to 55.5% of low-risk HEART2 scores (p < 0.001). The MACE outcomes were similar in low-risk HEART patients compared with low-risk HEART2 patients (2.2% versus 3.1%, p = 0.3021). The overall performance accuracy of using the HEART2 score to stratify chest pain patients with previous CIT was better than using the HEART score's (AUC 0.74 versus 0.71, p = 0.0082). CONCLUSIONS: Using the HEART2 score might be suitable to stratify low-to-moderate risk chest pain patients at ED with a similar 30-days MACE occurrence compared to the HEART score. More importantly, with the use of similar low-risk criteria (HEART2 ≤ 3), over 45% more chest pain patients with previous CIT performed could be discharged directly from ED.
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Schrader et al. (2022) conducted an observational in Chest pain (n=9,419). HEART2 score vs. HEART score was evaluated on Performance accuracy (AUC) for predicting 30-day major adverse cardiac events (MACE) in patients with previous cardiac imaging tests (p=0.0082). The HEART2 score demonstrated better overall performance accuracy than the HEART score for predicting 30-day major adverse cardiac events in emergency department chest pain patients with previous cardiac imaging tests (AUC 0.74 vs 0.71).
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