Morning Report 1/8/16
HEART score in the ED. Presented by Dr. Kopping. Edited by Dr. deSouza.
-Chest pain: Cause for more than 8k…no, 80k…no, 8 MILLION visits!!
-What this is about?
-Not the 60 year-old sweaty guy with crushing chest pain, STE, and trop of 4000 (How many of those do you see?)
-Not the 18 year-old girl elbowed in the chest, now with a bruise, and extremely tender
-It’s the 52 year-old with PMH of HTN c/o intermittent chest pain; ECG with V5/6 T inversion…Lots of variability in practice styles and this is the grand majority of ED chest pain patients
-Along comes the HEART score
-0 to 10 based on 5 criteria: History, Age, ECG, risk factors, troponin
Why I like:
-Applies to ALL chest pain ED patients
-Easy to use
-My job is to find ACS; HEART performs better than previous scoring systems at identifying ACS
-Alternative scoring systems such as TIMI predict complications of people who have “confirmed” ACS
-Study population- Netherlands is not the hot new neighborhood in Brooklyn
-Still requires a troponin level
HEART score and risk of major adverse cardiac events (MACE) at 6 weeks:
4-6: 12 %
Something that can be used but still needs some investigation in broad populations.
There is a University of Maryland chest pain protocol that was designed by a committee of MDs AND suits (risk managers and CMOs). It involves the use of a decision-making aid for patients for the purpose of shared decision-making. See link below.
1. Bachus et al. “Risk Scores for Patients with Chest Pain: Evaluation in the Emergency Department” Current Cardiology Reviews, 2011;(7):2-8
3. Six AJ, Backus BE, Kelder JC. Chest pain in the emergency room: value of the HEART score. Netherlands Heart Journal. 2008;16(6):191-6.