title: Documentation of HEART score discordance between emergency physician and cardiologist evaluations of ED patients with chest pain.
abstract: BACKGROUND
  A triage cardiology program, in which cardiologists provide consultation to the Emergency Department (ED), may safely reduce admissions. For patients with chest pain, the HEART Pathway may obviate the need for cardiology involvement, unless there is a difference between ED and cardiology assessments. Therefore, in a cohort concurrently evaluated by both specialties, we analyzed discordance between ED and cardiology HEART scores.
  
  
  METHODS
  We performed a single-center, cross-sectional, retrospective study of adults presenting to the ED with chest pain who had a documented bedside evaluation by a triage cardiologist. Separate ED and cardiology HEART scores were computed based on documentation by the respective physicians. Discrepancies in HEART score between ED physicians and cardiologists were quantified using Cohen κ coefficient.
  
  
  RESULTS
  Thirty-three patients underwent concurrent ED physician and cardiologist evaluation. Twenty-three patients (70%) had discordant HEART scores (κ = 0.13; 95% confidence interval, -0.02 to 0.32). Discrepancies in the description of patients' chest pain were the most common source of discordance and were present in more than 50% of cases. HEART scores calculated by ED physicians tended to overestimate the scores calculated by cardiologists. When categorized into low-risk or high-risk by the HEART Pathway, more than 25% of patients were classified as high risk by the ED physician, but low risk by the cardiologist.
  
  
  CONCLUSIONS
  There is substantial discordance in HEART scores between ED physicians and cardiologists. A triage cardiology system may help refine risk stratification of patients presenting to the ED with chest pain, even when the HEART Pathway tool is used.
authors.affiliation: Vanderbilt University School of Medicine, Nashville, TN. Electronic address: w.kelly.wu@vanderbilt.edu.
authors.forename: W Kelly
authors.initials: WK
authors.lastname: Wu
authors.affiliation: Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN. Electronic address: maya.yiadom@vanderbilt.edu.
authors.forename: Maame Yaa A B
authors.initials: MY
authors.lastname: Yiadom
authors.affiliation: Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN. Electronic address: sean.collins@vanderbilt.edu.
authors.forename: Sean P
authors.initials: SP
authors.lastname: Collins
authors.affiliation: Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN. Electronic address: wesley.self@vanderbilt.edu.
authors.forename: Wesley H
authors.initials: WH
authors.lastname: Self
authors.affiliation: Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN. Electronic address: ken.monahan@vanderbilt.edu.
authors.forename: Ken
authors.initials: K
authors.lastname: Monahan
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D000367:Age Factors; D000368:Aged; D000072096:Cardiologists; D002637:Chest Pain / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D003430:Cross-Sectional Studies; D003661:Decision Support Techniques; D004562:Electrocardiography; D004635:Emergency Medicine; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010820:Physicians; D012017:Referral and Consultation; D012189:Retrospective Studies; D018570:Risk Assessment; D014218:Triage; D014336:Troponin / Q000097:blood
chemical_list: D014336:Troponin