Why the study?
Disposition in ACS is pivotal in the emergency department, and the study aimed to evaluate the predictive value of the HEART score in ACS outcome and disposition.
Does the HEART score predict 1-month MACE and disposition better than the TIMI score in patients presenting to the emergency department with suspected ACS?
Does the HEART score predict 1-month MACE and disposition better than the TIMI score in patients presenting to the emergency department with suspected ACS?
The HEART score outperforms the TIMI score in predicting 1-month MACE and correlates well with hospital disposition and triage acuity in ED patients with suspected ACS.
Supports preferring HEART over TIMI for ED MACE risk stratification; leaves open need for prospective validation before practice change.
Objective: Disposition in acute coronary syndrome (ACS) is pivotal in an emergency department (ED). HEART score is a recent scoring system for finding primary endpoints in undetermined ACS. This study aimed at evaluating the predictive value of HEART score in ACS outcome and disposition. Methods: In this prospective study, all patients with chest pain presentation compatible with our inclusion criteria referring to ED were enrolled during one year. Demographic data, triage level, hospital length of stay, admission ward, coronary angiography result, HEART score, thrombolysis in myocardial infarction (TIMI) score, 1-month primary ACS endpoints and major adverse cardiac events (MACE) were evaluated. Results: In our studied population (200 cases), 49 patients (24.5%) had at least one score for MACE. Comparing the prognostic values of TIMI vs HEART score in MACE revealed that the HEART had a larger AUC. The best cut-off point of HEART score in MACE prediction was calculated to be ≥5. There was a statistically significant relation between HEART score and hospital length of stay. The higher the HEART score, the more probability of patients being admitted to either hospital cardiac ward or coronary care unit (CCU). There was a significant relationship between the triage level and HEART score. Patients with higher HEART score had more acuity (lower triage level 1 or 2). Conclusion: HEART predicted MACE better than TIMI in low risk ACS. Patients with higher HEART score were more admitted to the hospital with longer hospital stay and patients with lower HEART score had higher triage level with less acuity.
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Abbasian et al. (2021) studied this question.
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