title: HEART score performance in Asian and Caucasian patients presenting to the emergency department with suspected acute coronary syndrome.
abstract: BACKGROUND
  The HEART score is a simple and effective tool to predict short-term major adverse cardiovascular events in patients suspected of acute coronary syndrome. Patients are assigned to three risk categories using History, ECG, Age, Risk factors and Troponin (HEART). The purpose is early rule out and discharge is considered safe for patients in the low risk category. Its performance in patients of Asian ethnicity is unknown. We evaluated the performance of the HEART score in patients of Caucasian, Chinese, Indian and Malay ethnicity.
  
  
  METHODS
  The HEART score was assessed retrospectively in 3456 patients presenting to the emergency department with suspected acute coronary syndrome (1791 Caucasians, 1059 Chinese, 344 Indians, 262 Malays), assigning them into three risk categories.
  
  
  RESULTS
  The incidence of major adverse cardiovascular events within six weeks after presentation was similar between the ethnic groups. A smaller proportion of Caucasians was in the low risk category compared with Asians (Caucasians 35.8%, Chinese 43.5%, Indians 45.3%, Malays 44.7%, p<0.001). The negative predictive value of a low HEART score was comparable across the ethnic groups, but lower than previously reported (Caucasians 95.3%, Chinese 95.0%, Indians 96.2%, Malays 96.6%). Also the c-statistic for the HEART score was not significantly different between the groups.
  
  
  CONCLUSIONS
  These results show that the overall performance of the HEART score is equal among Caucasian and Asian ethnic groups. The event rate in the low risk group, however, was higher than reported in previous studies, which queries the safety of early discharge of patients in the low risk category.
authors.affiliation: 1 Laboratory of Experimental Cardiology, University Medical Centre Utrecht, The Netherlands.|2 ICIN - Netherlands Heart Institute, Utrecht, The Netherlands.|3 Department of Medicine, National University of Singapore, Singapore.
authors.forename: Vince C
authors.initials: VC
authors.lastname: de Hoog
authors.affiliation: 4 Department of Emergency Medicine, Singapore General Hospital, Singapore.
authors.forename: Swee Han
authors.initials: SH
authors.lastname: Lim
authors.affiliation: 1 Laboratory of Experimental Cardiology, University Medical Centre Utrecht, The Netherlands.
authors.forename: Ingrid Em
authors.initials: IE
authors.lastname: Bank
authors.affiliation: 1 Laboratory of Experimental Cardiology, University Medical Centre Utrecht, The Netherlands.|2 ICIN - Netherlands Heart Institute, Utrecht, The Netherlands.
authors.forename: Crystel M
authors.initials: CM
authors.lastname: Gijsberts
authors.affiliation: 5 Department of Emergency Medicine, National University Hospital, Singapore.
authors.forename: Irwani B
authors.initials: IB
authors.lastname: Ibrahim
authors.affiliation: 5 Department of Emergency Medicine, National University Hospital, Singapore.
authors.forename: Win Sen
authors.initials: WS
authors.lastname: Kuan
authors.affiliation: 5 Department of Emergency Medicine, National University Hospital, Singapore.
authors.forename: Shirley Bs
authors.initials: SB
authors.lastname: Ooi
authors.affiliation: 6 National Heart Centre Singapore, Singapore.
authors.forename: Terrance Sj
authors.initials: TS
authors.lastname: Chua
authors.affiliation: 3 Department of Medicine, National University of Singapore, Singapore.
authors.forename: E Shyong
authors.initials: ES
authors.lastname: Tai
authors.affiliation: 6 National Heart Centre Singapore, Singapore.|7 Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore.
authors.forename: Fei
authors.initials: F
authors.lastname: Gao
authors.affiliation: 1 Laboratory of Experimental Cardiology, University Medical Centre Utrecht, The Netherlands.|8 Department of Clinical Chemistry and Haematology, UMC Utrecht, The Netherlands.
authors.forename: Gerard
authors.initials: G
authors.lastname: Pasterkamp
authors.affiliation: 1 Laboratory of Experimental Cardiology, University Medical Centre Utrecht, The Netherlands.
authors.forename: Hester M
authors.initials: HM
authors.lastname: den Ruijter
authors.affiliation: 9 Department of Cardiology, UMC Utrecht, The Netherlands.
authors.forename: Pieter A
authors.initials: PA
authors.lastname: Doevendans
authors.affiliation: 10 Department of Cardiology, Meander Medical Centre, Amersfoort, The Netherlands.
authors.forename: Thierry X
authors.initials: TX
authors.lastname: Wildbergh
authors.affiliation: 9 Department of Cardiology, UMC Utrecht, The Netherlands.|10 Department of Cardiology, Meander Medical Centre, Amersfoort, The Netherlands.
authors.forename: Arend
authors.initials: A
authors.lastname: Mosterd
authors.affiliation: 11 Medicine NUS & Cardiovascular Research Institute, NUHS, Singapore.|12 Christchurch Heart Institute, University of Otago, New Zealand.
authors.forename: A Mark
authors.initials: AM
authors.lastname: Richards
authors.affiliation: 1 Laboratory of Experimental Cardiology, University Medical Centre Utrecht, The Netherlands.|2 ICIN - Netherlands Heart Institute, Utrecht, The Netherlands.|13 Surgery NUS & Cardiovascular Research Institute, NUHS, Singapore.
authors.forename: Dominique Pv
authors.initials: DP
authors.lastname: de Kleijn
authors.affiliation: 1 Laboratory of Experimental Cardiology, University Medical Centre Utrecht, The Netherlands.|9 Department of Cardiology, UMC Utrecht, The Netherlands.
authors.forename: Leo
authors.initials: L
authors.lastname: Timmers
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis* / Q000208:ethnology; D044466:Asian People; D004562:Electrocardiography; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012846:Singapore / Q000453:epidemiology; D014218:Triage / Q000379:methods*; D044465:White People
keywords: Acute coronary syndrome; HEART score; ethnicity; major adverse cardiovascular outcome; risk stratification