1 Acute coronary syndrome (ACS) is a potentially life‐threatening manifestation of CAD, where time is crucial in the initial management.Ī mainstay of the initial management is based on ischaemic and bleeding risk stratification, as recommended in current international clinical guidelines. More than seven million people die from CAD every year, accounting for 12.8% of all deaths. Int J Cardio 2013.Coronary artery disease (CAD) is the single most frequent cause of death worldwide. A Prospective Validation of the HEART Score for Chest Pain Patients at the Emergency Department. Chest Pain in the Emergency Room: Value of the HEART Score. Risk Scores for Patients with Chest Pain: Evaluation in the Emergency Department. A larger, prospective study with narrower confidence intervals in a US population would be nice, but best current evidence is that the HEART score performs better than TIMI and GRACE scores.

The Heart Score was developed in an ED setting in all patients with chest pain and not just ACS patients.2.2)Ĭonclusion: The HEART score provides a quick and reliable predictor of outcomes in chest pain patients presenting to the ED. Confidence interval was a bit wide when looking at the total study population (i.e.No comparison of Heart Score to clinical gestalt.Each ED had different cut-off values for positive troponins.Study performed on patient population from the Netherlands.High HEART Score (7 – 10) = 50.1% MACE Rate.Intermediate HEART Score (4 – 6) = 16.6% MACE Rate.Low HEART Score (0 -3) = 1.7% MACE Rate.Results of validation study (Different than original study shown above): Occurrence of major adverse cardiac events (MACE) at 6 weeks.2,440 unselected, chest pain patients from 10 hospitals.Has the HEART score been validated against TIMI and GRACE scores (Validation Study)? In truth, clinical judgement plays a huge role for physicians in the ED when evaluating chest pain patients, so wouldn’t it make sense to have a risk score that follows this? Well, that is exactly what the HEART score does! What is the HEART Score (Original Study)? c-statistic 0.70)Īll of the above scores are well validated, but none of them emphasizes patient history as part of the score, used in identification of ACS in the ED setting, and chest pain due to causes other than ACS were not evaluated in these trials. FRISC: Like TIMI, is simple to use but has a poor predictive power (i.e.Also patients not divided into different risk groups GRACE: Very complex to use and a large portion of the score is dependent on the patient age.TIMI: Simple to use, but has a poor predictive power (i.e.PURSUIT: Does not include troponin assays as part of score and the majority of the score is dependent on patient age.What is the applicability of each score to clinical practice in the ED? Currently, most guidelines and risk stratification scores focus on the identification of high risk ACS patients that would benefit from early aggressive therapies, but what about all the other chest pain patients that don’t have ACS… are they accounted for? What are some of the scoring methods currently used? Specifically, when dealing with ACS, dynamic ECG changes or positive cardiac biomarkers is pretty much a slam dunk admission in most cases, but a lack of these does not completely rule out ACS. The challenge in the ED is to not only to identify high risk patients but also to identify patients who can be safely discharged home. musculoskeletal pain, gastroesophageal reflux disease (GERD), pericarditis). acute coronary syndrome (ACS), pulmonary embolism, aortic dissection) and non-urgent diagnoses (i.e. Chest pain is a common presentation complaint to the emergency department (ED) and has a wide range of etiologies including urgent diagnoses (i.e.

Interpretation of timi score