title: A prospective validation of the HEART score for chest pain patients at the emergency department.
abstract: BACKGROUND
  The focus of the diagnostic process in chest pain patients at the emergency department is to identify both low and high risk patients for an acute coronary syndrome (ACS). The HEART score was designed to facilitate this process. This study is a prospective validation of the HEART score.
  
  
  METHODS
  A total of 2440 unselected patients presented with chest pain at the cardiac emergency department of ten participating hospitals in The Netherlands. The HEART score was assessed as soon as the first lab results and ECG were obtained. Primary endpoint was the occurrence of major adverse cardiac events (MACE) within 6 weeks. Secondary endpoints were (i) the occurrence of AMI and death, (ii) ACS and (iii) the performance of a coronary angiogram. The performance of the HEART score was compared with the TIMI and GRACE scores.
  
  
  RESULTS
  Low HEART scores (values 0-3) were calculated in 36.4% of the patients. MACE occurred in 1.7%. In patients with HEART scores 4-6, MACE was diagnosed in 16.6%. In patients with high HEART scores (values 7-10), MACE occurred in 50.1%. The c-statistic of the HEART score (0.83) is significantly higher than the c-statistic of TIMI (0.75)and GRACE (0.70) respectively (p<0.0001).
  
  
  CONCLUSIONS
  The HEART score provides the clinician with a quick and reliable predictor of outcome, without computer-required calculating. Low HEART scores (0-3), exclude short-term MACE with >98% certainty. In these patients one might consider reserved policies. In patients with high HEART scores (7-10) the high risk of MACE may indicate more aggressive policies.
authors: Department of Cardiology, University Medical Center, Utrecht, The Netherlands; Department of Emergency Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands. Electronic address: backus@heartscore.nl.
authors: B E
authors: BE
authors: Backus
authors: A J
authors: AJ
authors: Six
authors: J C
authors: JC
authors: Kelder
authors: M A R
authors: MA
authors: Bosschaert
authors: E G
authors: EG
authors: Mast
authors: A
authors: A
authors: Mosterd
authors: R F
authors: RF
authors: Veldkamp
authors: A J
authors: AJ
authors: Wardeh
authors: R
authors: R
authors: Tio
authors: R
authors: R
authors: Braam
authors: S H J
authors: SH
authors: Monnink
authors: R
authors: R
authors: van Tooren
authors: T P
authors: TP
authors: Mast
authors: F
authors: F
authors: van den Akker
authors: M J M
authors: MJ
authors: Cramer
authors: J M
authors: JM
authors: Poldervaart
authors: A W
authors: AW
authors: Hoes
authors: P A
authors: PA
authors: Doevendans
mesh_terms: D000368:Aged; D002637:Chest Pain / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D017023:Coronary Angiography / Q000379:methods*; D003937:Diagnosis, Differential; D004562:Electrocardiography; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D009426:Netherlands / Q000453:epidemiology; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate / Q000639:trends
keywords: Acute coronary syndrome; Chest pain; Emergency room; HEART score; Risk score