Risk stratification for patients presenting with chest pain in the emergency department
The HEART score is a scoring system for patients presenting with chest pain in the emergency department. By assigning patient history, ECG, age, risk factors, and troponin, patients receive a score on a scale of 0‒10.
|ECG||Significant ST depression||2|
|Nonspecific repolarisation disturbance||1|
|Risk factors||≥3 risk factors or history of atherosclerotic disease||2|
|1 or 2 risk factors||1|
|No risk factors known||0|
* Risk factors include hypercholesterolemia, hypertension, diabetes mellitus, cigarette smoking, positive family history, obesity (BMI >30).
Risk stratification is determined by patient’s total score.
Scores 0-3: Low risk with 0.9-1.7% risk of 6-week MACE**. Recommend discharge with PCP follow-up.
Scores 4-6: Moderate risk with 12-16.6% risk of 6-week MACE**. Recommend admission to Observation for further evaluation OR if negative troponin at 0 and 3 hrs, order outpatient stress test.
Scores ≥7: High risk with 50-65% risk of 6-week MACE**. Recommend admission for inpatient evaluation and cardiology consultation.
** MACE (Major Adverse Cardiac Event) is defined as all-cause mortality, myocardial infarction, or coronary revascularization.
|1.||Six AJ, Backus BE, Kelder JC. Chest pain in the emergency room: value of the HEART score. Neth Heart J. 2008;16(6):191-6. Abstract|
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Developer: Sirikarn Napan, MD, FACC