A prehospital modified HEART score identified 33.2% of chest pain patients as low risk, achieving a negative predictive value of 98.1% for 30-day major adverse cardiac events.
Cohort (n=794)
No
Does a prehospital modified HEART score predict 30-day MACE in adult patients with undifferentiated chest pain transported by EMS?
A prehospital modified HEART score effectively identifies low-risk chest pain patients with a high negative predictive value for 30-day major adverse cardiac events.
Effect estimate: OR 9.2 (95% CI 3.6-23.0)
Absolute Event Rate: 1.9% vs 15.1%
Introduction The History, Electrocardiogram (ECG), Age, Risk Factors, and Troponin (HEART) score is a decision aid designed to risk stratify emergency department (ED) patients with acute chest pain. It has been validated for ED use, but it has yet to be evaluated in a prehospital setting. Hypothesis A prehospital modified HEART score can predict major adverse cardiac events (MACE) among undifferentiated chest pain patients transported to the ED. METHODS: A retrospective cohort study of patients with chest pain transported by two county-based Emergency Medical Service (EMS) agencies to a tertiary care center was conducted. Adults without ST-elevation myocardial infarction (STEMI) were included. Inter-facility transfers and those without a prehospital 12-lead ECG or an ED troponin measurement were excluded. Modified HEART scores were calculated by study investigators using a standardized data collection tool for each patient. All MACE (death, myocardial infarction MI, or coronary revascularization) were determined by record review at 30 days. The sensitivity and negative predictive values (NPVs) for MACE at 30 days were calculated. RESULTS: Over the study period, 794 patients met inclusion criteria. A MACE at 30 days was present in 10.7% (85/794) of patients with 12 deaths (1.5%), 66 MIs (8.3%), and 12 coronary revascularizations without MI (1.5%). The modified HEART score identified 33.2% (264/794) of patients as low risk. Among low-risk patients, 1.9% (5/264) had MACE (two MIs and three revascularizations without MI). The sensitivity and NPV for 30-day MACE was 94.1% (95% CI, 86.8-98.1) and 98.1% (95% CI, 95.6-99.4), respectively. CONCLUSIONS: Prehospital modified HEART scores have a high NPV for MACE at 30 days. A study in which prehospital providers prospectively apply this decision aid is warranted. Stopyra JP , Harper WS , Higgins TJ , Prokesova JV , Winslow JE , Nelson RD , Alson RL , Davis CA , Russell GB , Miller CD , Mahler SA . Prehospital modified HEART score predictive of 30-day adverse cardiac events. Prehosp Disaster Med. 2018;33(1):58-62.
Stopyra et al. (Wed,) conducted a cohort in Undifferentiated chest pain (n=794). Modified HEART score vs. High-risk assessment was evaluated on 30-day major adverse cardiac events (MACE) (OR 9.2, 95% CI 3.6-23.0). A prehospital modified HEART score identified 33.2% of chest pain patients as low risk, achieving a negative predictive value of 98.1% for 30-day major adverse cardiac events.