Low Risk Chest Pain (HEART score)

Chest pain is one of the more common presenting complaints to our Emergency Department. We daily tease out those who require further testing for acute coronary syndromes vs those who can be safely discharged home. If we approaching these patients in a consistent way, we can hopefully create a consistent and safe process for evaluating these patients. I propose the HEART score. Unlike the other scores (PURSUIT, TIMI, GRACE, FRISC), HEART performs well and was tested in the ED.

The University of Maryland created a wonderful PDF which can be used with patients in shared decision making.

Delete the rows which don’t apply, using F2 to jump from row to row.

The Heart Score for Chest Pain Patients in the ED

H : HISTORY SUSPICIOUS
*** +2 : highly suspicious
*** +1 : moderately suspicious
*** 0 : low or no suspicion

E : ECG
*** +2 : ST-Depressions
*** +1 : Non-specific
*** 0 : Normal

A : AGE
*** +2 : >= 65
*** +1 : 45-65
*** 0 : < 45

R : RISK FACTORS (DM, smokes within 1 month, HTN, HLP, Fam Hx, obesity)
*** +2 : 3+ risk factors
*** +1 : 1-2
*** 0 : none

T : Troponin
*** +2 : > 0.3 (3x nl)
*** +1 : 0.1 - 0.3
*** 0 : nl

TOTAL SCORE: ***

Using the HEART Score (Backus 2013), patients with low scores defined as 0-3 have a 1.7% risk of major adverse cardiac events. Addition of a second troponin and stress test, decreases this risk to 1%. These risks were discussed with the patient, and they opted to
- ***stay for a second set of ECG/troponin stress test in exchange for an approximate 1% risk
- ***accept the 1.7% risk and go home now

  1. Six AJ, Backus BE, Kelder JC. Chest pain in the emergency room: value of the HEART score. Neth Heart J. 2008;16(6):191-196.
  2. Backus BE, Six AJ, Kelder JC, et al. A prospective validation of the HEART score for chest pain patients at the emergency department. Int J Cardiol. 2013;168(3):2153-2158.
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Low Risk Chest Pain (HEART score)

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