For the definition of AMI we used the ESC guidelines. Of course, every decrease in risk of endpoints is desirable, but HEART with a single troponin is already a very reliable predictor of MACE/ACS. shows that HEART ≤3 with 2 sets of negative troponin has a NPV of >99% for MACE. With that single troponin value, the HEART Score has a NPV >98%. I had a few questions about definitions - was troponin “on admission” the initial troponin drawn in the ER upon arrival there? Also, how did you define AMI in patients with a troponin already >3x normal? Was it AMI if the troponin continued to trend up, if no obvious EKG changes were seen? In all our validation studies, we used the first troponin on arrival. A minor pitfall is that the user needs at least some experience taking a chest pain history and reading an ECG to interpret these two elements of the score. What pearls, pitfalls and/or tips do you have for users of the HEART Score for Major Cardiac Events? Are there cases in which it has been applied, interpreted, or used inappropriately? The great benefit of the HEART score is that it is applicable to all chest pain patients in the ED or ACS unit. The structure of the five elements with a 0, +1, and +2 scoring system (analogous to the Apgar score) helps to translate a long history and examination of a patient with chest pain into a comprehensible score of 0 to 10. Most widely validated for regular sensitivity troponin, though has also been recently studied using high sensitivity troponin ( Ljung 2019).įrom Barbra Backus, MD, PhD, co-author of the HEART Score: Why did you develop the HEART Score for Major Cardiac Events? Was there a clinical experience that inspired you to create this tool for clinicians? The HEART score was created based on expert opinion through examination of many patients with chest pain.The HEART Score outperforms the TIMI Score for UA/NSTEMI, safely identifying more low-risk patients.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 user needs some experience taking a detailed chest pain history and reading EKGs to adequately apply these two components of the score.Identifies patients with higher risk of having a MACE (all-cause mortality, myocardial infarction, or coronary revascularization) in the following 6 weeks.Designed to risk stratify patients with undifferentiated chest pain, not those already diagnosed with ACS.Each of these is scored with 0, 1 or 2 points. HEART is an acronym of its components: History, EKG, Age, Risk factors, and troponin.Helps ED providers risk-stratify chest pain patients into low, moderate, and high-risk groups.
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