title: HEART score: a simple and useful tool that may lower the proportion of chest pain patients who are admitted.
abstract: OBJECTIVE
  Evaluation of patients with chest pain in the emergency department is challenging. HEART score can be easily used and includes history, electrocardiogram (ECG), age, risk factors, and troponin. The aims were to validate this score and estimate to what extent it can reduce the admission rate.
  
  
  METHODS
  A total of 410 consecutive patients with chest pain, who presented to the emergency department with no ST-segment elevations, were included and followed for 3 months regarding the combined endpoint of cardiovascular death, myocardial infarction, or unplanned revascularization.
  
  
  RESULTS
  Thirty (7.3%) patients attained one or more combined endpoint. Of 247 (60.2%) patients with HEART score 0-3, 1 patient (0.4%) had a combined endpoint (unplanned revascularization). Of 144 (35.1%) patients with HEART score 4-6, 19 (13.2%) patients had a combined endpoint. Of 19 (4.6%) patients with HEART score 7-10, 10 (52.6%) patients had a combined endpoint. A total of 181 (44.1%) patients were admitted to the hospital for further evaluation. Of these patients, 62 (34.3%) had a HEART score of 0-3 and of whom 45 (72.5%) had a final diagnosis indicating that hospital admission may have been avoided. Among the 5 HEART score parameters, patient history, ECG abnormalities, and elevated troponin values were independent predictors of the combined endpoint.
  
  
  CONCLUSIONS
  In conclusion, HEART score may be a useful tool for evaluation of patients with chest pain and identify a low-risk group in which admission and further investigations may not be necessary. However, an even simpler score, including only history, troponin level, and ECG findings, may be sufficient.
authors.affiliation: Department of Medicine, Section of Cardiology, Karolinska Institutet, Karolinska University Hospital, Huddinge, Stockholm, Sweden. a.Melki@karolinska.se
authors.forename: Dina
authors.initials: D
authors.lastname: Melki
authors.forename: Tomas
authors.initials: T
authors.lastname: Jernberg
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications / Q000175:diagnosis*; D000328:Adult; D000367:Age Factors; D000368:Aged; D002637:Chest Pain / Q000209:etiology*; D015331:Cohort Studies; D004562:Electrocardiography; D004636:Emergency Service, Hospital; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D019210:Troponin I / Q000097:blood; D020107:Troponin T / Q000097:blood
chemical_list: D019210:Troponin I; D020107:Troponin T