The HEART Score Is Safe to Use in the Emergency Department

From the NEJM:

The HEART score — based on History, Electrocardiogram, Age, Risk factors, and Troponin level — provides risk stratification and disposition recommendations (inpatient admission, observation, or discharge) for emergency department (ED) patients presenting with chest pain. It has been externally validated and is used by some hospitals as part of their risk-stratification algorithms. However, its effect on use of healthcare resources is not known.

In a Dutch study, nine EDs switched from usual care to use of the HEART score in random order. Discharged patients were followed up with troponin testing the same or next day. The primary outcome was incidence of major adverse cardiac events (MACE) within 6 weeks. Adherence with the score’s recommendations and resource use were also evaluated.

Roughly 3650 patients were included in the analysis. The incidence of MACE was 1.3% lower with HEART care than with usual care. The incidence of MACE among the 715 patients classified as low-risk by HEART was 2.0%, including one death from unknown causes. There were no significant differences in the use of healthcare resources between HEART care and usual care, likely because 41% of patients classified as low-risk (and thus appropriate for discharge) received additional observation, second troponin measurement, and stress testing instead.

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