title: Clinical utility of the HEART score in patients admitted with chest pain to an inner-city hospital in the USA.
abstract: BACKGROUND
  Chest pain is one of the most common presentations to a hospital, and appropriate triaging of these patients can be challenging. The HEART score has been used for such purposes in some countries and only a few validation studies from the USA are available. We aim to determine the utility of the HEART score in patients presenting with chest pain to an inner-city hospital in the USA.
  
  
  METHODS
  We retrospectively screened 417 consecutive patients admitted with chest pain to the observation/telemetry units at Einstein Medical Center Philadelphia. After applying inclusion and exclusion criteria, 299 patients were included in the analysis. Patients were divided into low-risk (0-3) and intermediate-high (≥4)-risk HEART score groups. Baseline characteristics, thrombolysis in myocardial infarction score, need for revascularization during index hospitalization, and major adverse cardiovascular events (MACE) at 6 weeks and 12 months were recorded.
  
  
  RESULTS
  There were 98 and 201 patients in the low-score group and intermediate-high-score group, respectively. Compared with the low-score group, patients in the intermediate-high-risk group had a higher incidence of revascularization during the index hospital stay (16.4 vs. 0%; P=0.001), longer hospital stay, higher MACE at 6 weeks (9.5 vs. 0%) and 12 months (20.4 vs. 3.1%), and higher cardiac readmissions. HEART score of at least 4 independently predicted MACE at 12 months (odds ratio 7.456, 95% confidence interval: 2.175-25.56; P=0.001) after adjusting for other risk factors in regression analysis.
  
  
  CONCLUSIONS
  HEART score of at least 4 was predictive of worse outcomes in patients with chest pain in an inner-city USA hospital. If validated in multicenter prospective studies, the HEART score could potentially be useful in risk-stratifying patients presenting with chest pain in the USA and could impact clinical decision-making.
authors.affiliation: aDepartment of Medicine bDepartment of Medicine, Division of Cardiology, Einstein Medical Center, Philadelphia cDepartment of Cardiology, Lehigh Valley Healthcare Network, Allentown, Pennsylvania dDepartment of Medicine, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA.
authors.forename: Soumya
authors.initials: S
authors.lastname: Patnaik
authors.forename: Mahek
authors.initials: M
authors.lastname: Shah
authors.forename: Yaser
authors.initials: Y
authors.lastname: Alhamshari
authors.forename: Pradhum
authors.initials: P
authors.lastname: Ram
authors.forename: Ritika
authors.initials: R
authors.lastname: Puri
authors.forename: Marvin
authors.initials: M
authors.lastname: Lu
authors.forename: Percy
authors.initials: P
authors.lastname: Balderia
authors.forename: John B
authors.initials: JB
authors.lastname: Imms
authors.forename: Obiora
authors.initials: O
authors.lastname: Maludum
authors.forename: Vincent M
authors.initials: VM
authors.lastname: Figueredo
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D002637:Chest Pain / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D017023:Coronary Angiography; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D004562:Electrocardiography; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006786:Hospitals, Urban / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D000072658:Non-ST Elevated Myocardial Infarction / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D016017:Odds Ratio; D010343:Patient Admission / Q000706:statistics & numerical data*; D015143:Philadelphia / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013686:Telemetry / Q000379:methods; D014481:United States / Q000453:epidemiology