![]() ![]() Clinically relevant value of the HEART score as a risk stratification tool was reaffirmed. In this study, the performance of the HEART score was prospectively compared to Thrombolysis in Myocardial Infarction (TIMI) and Global Registry of Acute Coronary Events (GRACE) scores in 2,440 unselected patients that presented to the ED in 10 participating hospitals in The Netherlands. Moreover, only one of the subjects with HEART score ≤ 3 suffered an event (2.5%) compared to 20.3% and 72.7% of those with the scores between 4 to 6 and ≥ 7, respectively.Īpproximately 2 years later the first validation study was reported by Backus et al. Their analysis found a very promising, almost linear, relationship between the HEART score and the endpoints. One or more endpoints occurred in 24.1% of the subjects, all of them occurred within the first 3 months of enrollment. The mean follow-up was, in fact, quite long at 423 ± 106 days, and only two of their subjects were lost to follow-up. The primary endpoints were acute myocardial infarction (AMI), percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG) and death plus a combined endpoint of AMI, PCI, CABG, and death. An Access Accu Troponin I assay with cut-off ≤ 0.04 ng/mL was used. In their original report, they prospectively evaluated 122 patients presenting to the ED with acute chest pain. Utilizing an approach similar to the time-tested Apgar score (globally utilized to assess the need of a newborn for intensive care), they developed a new scoring system based on a sum of five clinical factors. In 2008, recognizing the lack of a practical tool for risk stratifying a large number of their patients who presented to ED with acute chest pain, Six et al first proposed their novel idea of the HEART score. The original report and initial validation studies Original HEART Score Components and Scoring More importantly we hope to emphasize certain practical considerations and potential pitfalls when one applies the HEART score in clinical practice. ![]() We did not intend to review all of them here, but rather to focus on its historical development and subsequent modification of the HEART score. As expected, since its original report 15 years ago, there have been countless publications relating to the HEART score. Unsurprisingly, given the simplicity and well-suited name, the history, electrocardiogram, age, risk factors, and troponin (HEART) score has over the years become widely recognized and is at present being routinely utilized worldwide for acute chest pain risk stratification. Shortly thereafter, multiple validation studies began to emerge, including from multicenter institutions, confirming its relatively high predictive value for intermediate (6-week) major cardiovascular events. ![]() This now well-known risk score was first introduced by Six et al in 2008. Keywords: HEART score Risk stratification Modified HEART Risk assessment Cardiology ACS Acute chest pain A Quick Look Back in TimeĬurrently one of the most used tools for risk stratifying patients presenting to an emergency department (ED) with acute chest pain is a composite score based on five clinical considerations of history, electrocardiogram (ECG), age, risk factors, and troponin ( Table 1). We also highlight the strength of the HEART score in comparison with other risk stratification tools and the current guidelines. In this article we review how the HEART score has evolved and taken on various modifications to circumvent some of its limitations. However, partly due to its focus on simplicity, the HEART score has some limitations. Relatively soon after its inception in 2008, a number of validation studies on the HEART score showed it to be superior to Thrombolysis in Myocardial Infarction (TIMI) and Global Registry of Acute Coronary Events (GRACE) scores and at least as accurate to other existing scores for predicting short-term major adverse cardiovascular events (MACEs). The history, electrocardiogram, age, risk factors, and troponin (HEART) score is currently a widely used tool for acute chest pain risk stratification. ![]()
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