II. Indications
- Chest Pain risk stratification in the emergency department
III. Criteria
- History
- Score 2: History highly suspicious for coronary syndrome
- Score 1: History moderately suspicious for coronary syndrome
- Score 0: History slightly suspicious for coronary syndrome
-
Electrocardiogram (EKG)
- Score 2: EKG with Significant ST Depression or ST Elevation
- Score 1: EKG with Non-specific repolarization disturbance
- Score 0: EKG Normal (including Early Repolarization)
- Age
- Score 2: Age 65 years or older
- Score 1: Age 45 to 65 years old
- Score 0: Age <45 years old
- Risk Factors
- Score 2: Three or more risk factors for or history of atherosclerotic disease
- Score 1: One to 2 risk factors for atherosclerotic disease
- Score 0: No risk factors for atherosclerotic disease
- Troponin
IV. Interpretation: Based on sum of 5 criteria above (of total possible points 10)
- Total Score 0-3
- Adverse outcome risk: 2.5% (very low to low risk)
- Supports early discharge with appropriate follow-up
- Total Score 4-6
- Adverse outcome risk: 20.3% (moderate risk)
- Supports admission with standard rule-out management (serial Troponins) and stress testing
- Total Score 7-10
- Adverse outcome risk: 72.7% (high to very high risk)
- Risk in first 30 days >50%
- Supports early aggressive management and typically with cardiac catheterization
V. Interpretation: History Component Modifiers
- Background
- History component of the HEART Score is subjective
- Criteria have been developed to assign ACS suspicion based on more objective scoring
- Criteria (assign one point for each positive finding)
- Chest Pain and Vomiting
- Chest Pain and diaphoresis
- Chest Pain radiating to either side of the torso
- Chest Pain worse with exertion
- Interpretation
- Score 0: Assign 0 history points on HEART Score (slightly suspicious for ACS)
- Score 1: Assign 1 history point on HEART Score (moderately suspicious for ACS)
- Score >=2: Assign 2 history points on HEART Score (highly suspicious for ACS)
- References
- Mattu (2023) EM:Rap 23(6): 18-9
VI. Efficacy: General
- Allows for meaningful risk stratification of Low Risk Chest Pain
- Identifies 36% of Low Risk Chest Pain patients as lower risk for adverse event (HEART Score 0-3)
- Contrast with TIMI Score which only risk stratified 5% of the same low risk patients
- Identifies high risk patients (HEART Score >6) who have a >50% risk of adverse event in the next 30 days
- References
- Swadron and Mallon in Herbert (2015) EM:Rap 15(12): 11-2
- Bachus (2013) Int J Cardiol 168(3): 2153-8 +PMID: 23465250 [PubMed]
VII. Efficacy: HEAR Score (Experimental)
- HEAR score (without Troponin) is being evaluated for efficacy as of 2023
- HEAR Score 0 to 1 is associated with low risk stratification and early ED discharge
- References