HEART Score for Major Cardiac Events
Why Use
Objectively risk-stratifies patients into low, moderate, and high-risk categories, helping guide management, leading to better resource utilization, shorter hospital and ED stays for low risk patients, and earlier interventions for moderate- and high-risk patients.
When to Use
Any ED patient with chest pain that the physician deems appropriate for an ACS workup.
Formula
Pearls / Pitfalls
Helps ED providers risk-stratify chest pain patients into low, moderate, and high-risk groups. HEART is an acronym of its components: History, EKG, Age, Risk factors, and troponin. Each of these is scored with 0, 1 or 2 points. Designed to risk stratify patients with undifferentiated chest pain, not those already diagnosed with ACS. Identifies patients with higher risk of having a MACE (all-cause mortality, myocardial infarction, or coronary revascularization) in the following 6 weeks. The user needs some experience taking a detailed chest pain history and reading EKGs to adequately apply these two components of the score. Sometimes compared to TIMI Score for UA/NSTEMI and the GRACE ACS Risk Score (older ACS scores), but the latter two differ from the HEART in that they measure risk of death for patients with diagnosed ACS. The HEART Score outperforms the TIMI Score for UA/NSTEMI, safely identifying more low-risk patients. Most widely validated for regular sensitivity troponin, though has also been recently studied using high sensitivity troponin ( Ljung 2019 ).
Management
Scores 0-3 : 0.9-1.7% risk of adverse cardiac event. In the HEART Score study, these patients were discharged (0.99% in the retrospective study, 1.7% in the prospective study). Scores 4-6 : 12-16.6% risk of adverse cardiac event. In the HEART Score study, these patients were admitted to the hospital. (11.6% retrospective, 16.6% prospective). Scores ≥7 : 50-65% risk of adverse cardiac event. In the HEART Score study, these patients were candidates for early invasive measures. (65.2% retrospective, 50.1% prospective). A MACE (Major Adverse Cardiac Event) was defined as all-cause mortality, myocardial infarction, or coronary revascularization.
Critical Actions
Do not use if new ST-segment elevation requiring immediate intervention or clinically unstable patients.
More Information
Major Adverse Cardiac Event (MACE) was defined in this study as: AMI, PCI, CABG, death. Ryan Radecki of EM Literature of Note recommended emergency physicians use the HEART Score over the TIMI or GRACE scores for emergency department risk stratification of patients with possibly cardiac complaints.