HEART Score, an optimal tool for predicting cardiovascular events in chest pain patients in emergency department: a prospective single-center study
Abstract
Objective: Chest pain is a prevalent and potentially life-threatening presentation in emergency departments, necessitating prompt and precise risk stratification to identify patients at high risk, particularly those with acute coronary syndrome (ACS). This study evaluates the predictive accuracy of the HEART score in stratifying short-term major adverse cardiac events (MACE) risk among chest pain patients in Bandar Abbas, aiming to enhance clinical decision-making and resource utilization in emergency departments. Method: This prospective observational study was conducted on patients presenting with chest pain at Shahid Mohammadi Hospital’s emergency department. Patients aged ≥18 years with chest pain were included, while those with STEMI or incomplete records were excluded. The HEART score was used for risk stratification, and patients were classified into low, moderate, or high-risk groups. The primary outcome was MACE within six weeks, confirmed via follow-up calls. Data analysis included logistic regression and ROC curve analysis. Result: A total of 1,501 individuals participated in the study, with a mean age of 48.99±14.71 years. Among the participants, 28.6% were diagnosed with MACE. The most common risk factors for MACE included a history of coronary artery disease (79.1%) and hypertension (77.2%). Based on the HEART score, patients were categorized into low-risk (≤ 3), moderate-risk (4-6), and high-risk (≥ 7) groups. The majority of non-MACE patients were classified as low-risk (78.3%), while 65.6% of MACE patients fell into the moderate-risk category. The mean HEART score was significantly higher in the MACE group (5.73±1.68) compared to the non-MACE group (2.31± 1.54). The optimal HEART score cutoff for predicting MACE was determined to be 3.5, with the ROC curve demonstrating strong predictive performance (AUC=0.932). Conclusion: The HEART score is a reliable tool for risk stratification in chest pain patients in the emergency department. Our study shows that a score of ≤ 3.5 indicates low risk, while higher scores predict a greater likelihood of MACE. The HEART score effectively guides clinical decisions, highlighting its high sensitivity and specificity for identifying low- and high-risk patients, making it an essential tool for patient management in emergency settings.
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