title: Mean HEART scores for hospitalized chest pain patients are higher in more experienced providers.
abstract: BACKGROUND
  The HEART score has been validated as a predictor of major adverse cardiac events (MACEs) in emergency department patients complaining of chest pain. Our objective was to determine the extent of physician variation in the HEART score of admitted patients stratified by years of experience.
  
  
  METHODS
  We performed a retrospective medical record review at an academic tertiary care emergency department to determine HEART score, outcome of hospitalization, and 30-day MACE. Electrocardiograms were graded by consensus between 3 physicians. We used analysis of variance to determine the difference in mean HEART scores between providers, Fisher's exact test to determine difference in MACE by duration of training, and logistic regression to determine predictors of low-risk admission (HEART score≤3).
  
  
  RESULTS
  The average mean HEART score for 19 full-time physicians was 4.41 (SD 0.43). Individually, there was no difference in mean scores (P=.070), but physicians with 10-15 years of experience had significantly higher mean scores than those with 0-5 years of experience (mean HEART score 4.65 vs 3.93, P=.012). Those with 10-15 years of experience also had a significantly higher proportion of MACE in their admitted cohort (15.3%, P=.002).
  
  
  CONCLUSIONS
  More experienced providers admitted higher-risk patients and were more likely to admit patients who would experience a MACE. More research is needed to determine whether adding the HEART score for clinical decision making can be used prospectively to increase sensitivity for admitting patients at high risk for MACE and to decrease admissions for chest pain in lower-risk patients by less experienced providers.
authors.affiliation: Department of Emergency Medicine, Washington Hospital Center, 110 Irving St NW, Washington, DC, 20008.
authors.forename: Jeff
authors.initials: J
authors.lastname: Dubin
authors.affiliation: Department of Emergency Medicine, Washington Hospital Center, 110 Irving St NW, Washington, DC, 20008.
authors.forename: Eric
authors.initials: E
authors.lastname: Kiechle
authors.affiliation: Department of Emergency Medicine, Washington Hospital Center, 110 Irving St NW, Washington, DC, 20008. Electronic address: matt.d.wilson@medstar.net.
authors.forename: Matt
authors.initials: M
authors.lastname: Wilson
authors.affiliation: Department of Emergency Medicine, Washington Hospital Center, 110 Irving St NW, Washington, DC, 20008.
authors.forename: Christian
authors.initials: C
authors.lastname: Timbol
authors.affiliation: Department of Emergency Medicine, Washington Hospital Center, 110 Irving St NW, Washington, DC, 20008.
authors.forename: Rahul
authors.initials: R
authors.lastname: Bhat
authors.affiliation: Department of Emergency Medicine, Washington Hospital Center, 110 Irving St NW, Washington, DC, 20008.
authors.forename: Dave
authors.initials: D
authors.lastname: Milzman
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000401:mortality*; D002637:Chest Pain / Q000175:diagnosis* / Q000209:etiology; D002983:Clinical Competence; D000066491:Clinical Decision-Making; D004562:Electrocardiography; D004635:Emergency Medicine; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology*; D010820:Physicians; D012189:Retrospective Studies; D018570:Risk Assessment