A Methodological Appraisal of the HEART Score and Its Variants Response

Abstract Pulmonary hypertension (PH) can lead to premature mortality in fed cattle and is often called Feedlot Heart Disease (FHD). To date, pulmonary arterial pressure (PAP) has been the only indicator trait of PH that has been evaluated. The objective of this study was to evaluate relationships between heart score (using heart score as a phenotype for PH) and PAP, carcass, and feed efficiency traits in fattening Angus steers. Our hypothesis was that feed efficiency and carcass traits, along with PAP, would demonstrate a strong relationship with heart score. Feed efficiency, carcass, PAP and heart score data from 89 Black Angus steers from Colorado State University Beef Improvement Center were collected and used for this study. Evaluations were performed using a multiple linear regression model, which included heart score as a categorical fixed effect and age as a continuous fixed effect. Least Square Means, pairwise comparisons, and ANOVA tables were constructed per trait. PAP (P < 0.001) showed an important relationship to heart score and average dry matter (P < 0.10) intake approached importance to heart score. In general, feed efficiency and carcass traits decreased as heart score increased, but PAP was the only trait with a strong relationship to heart score (P < 0.05). This led us to reject our hypothesis.

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A single high-sensitivity cardiac troponin T compared to the HEART score for a rapid rule-out of acute myocardial infarction at a prehospital emergency clinic

European Heart Journal ◽

10.1093/ehjci/ehaa946.1680 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

T.R Johannessen ◽

D Atar ◽

O.M Vallersnes ◽

A.C.K Larstorp ◽

I Mdala ◽

...

Keyword(s):

Primary Care ◽

Cardiac Troponin ◽

Troponin T ◽

High Sensitivity ◽

Low Risk ◽

Symptom Duration ◽

Funding Source ◽

Emergency Setting ◽

Heart Score ◽

Rule Out

Abstract Background Patients presenting with acute chest pain outside of hospitals represent a diagnostic challenge. Purpose We aimed to validate whether a single high-sensitivity cardiac troponin T (hs-cTnT) safely can rule out acute myocardial infarction (AMI) in a primary care emergency setting. In addition, we aimed to investigate if the hs-HEART (History, Electrocardiogram (ECG), Age, Risk factors, and hs-Troponin) score would add valuable diagnostic information. Methods This is a secondary analysis from a prospective diagnostic study, including 1711 patients with acute non-specific chest pain presenting to a primary care emergency clinic from November 2016 to October 2018. The European Society of Cardiology (ESC) 0/1-hour algorithm triages patients towards direct rule-out if the 0-hour hs-cTnT is below 5 ng/L, combined with a normal ECG and a 3-hour symptom duration. The hs-HEART score (0–10 points) was calculated retrospectively, and a score ≤3 points was considered low-risk. In addition, a modified hs-HEART score, with more comparable hs-cTnT cut-off values, was applied. The primary endpoint was AMI during the index episode; the secondary the 90-day incidence of AMI (including index) and all-cause death. Results Among 1711 patients, 61 (3.6%) had an AMI, and 525 (30.7%) were assigned towards direct rule-out. With no AMIs in this group, the rule-out safety was high (negative predictive value (NPV) and sensitivity 100%). The hs-HEART score triaged more patients (n=966) as low-risk, but missed six AMIs (NPV 99.4% and sensitivity 90.2%). The modified hs-HEART score (n=707, AMI=3) increased the low-risk sensitivity to 95.1%. The 90-day incidence of AMI and all-cause death in the direct rule-out, low-risk hs-HEART, and modified hs-HEART group, were 0.0%, 0.7%, and 0.4%, respectively. Conclusions The ESC direct rule-out approach, with a single hs-cTnT below 5 ng/L, combined with a normal ECG, and a 3-hour symptom duration, is superior to the two hs-HEART scores in ruling out AMI in a primary care emergency setting. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): The Norwegian Research Fund for General Practice

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Heart score as a risk stratification tool to assess patients with chest pain in emergency: A prospective observational study

Indian Heart Journal ◽

10.1016/j.ihj.2020.11.035 ◽

2020 ◽

Vol 72 ◽

pp. S9-S10

Author(s):

Laxmi Adhikari ◽

Nikhil Choudhary

Keyword(s):

Chest Pain ◽

Observational Study ◽

Risk Stratification ◽

Prospective Observational Study ◽

Heart Score ◽

Risk Stratification Tool

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APPLICATION OF THE HEART SCORE CONCEPT TO THE ELECTROCARDIOGRAPHY OF OLYMPIC ATHLETES

The Medical Journal of Australia ◽

10.5694/j.1326-5377.1970.tb63144.x ◽

1970 ◽

Vol 2 (16) ◽

pp. 728-730 ◽

Cited By ~ 9

Author(s):

J. D. Steel ◽

G. A. Stewart ◽

A. H. Toyne

Keyword(s):

Heart Score ◽

Olympic Athletes

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Chest pain in general practice: a systematic review of prediction rules

BMJ Open ◽

10.1136/bmjopen-2018-027081 ◽

2019 ◽

Vol 9 (2) ◽

pp. e027081 ◽

Cited By ~ 2

Author(s):

Ralf E Harskamp ◽

Simone C Laeven ◽

Jelle CL Himmelreich ◽

Wim A M Lucassen ◽

Henk C P M van Weert

Keyword(s):

Systematic Review ◽

General Practice ◽

Chest Pain ◽

Coronary Disease ◽

Clinical Decision ◽

Clinical Judgement ◽

Predictive Values ◽

Heart Score ◽

Coronary Syndrome ◽

Rule Out

ObjectiveTo identify and assess the performance of clinical decision rules (CDR) for chest pain in general practice.DesignSystematic review of diagnostic studies.Data sourcesMedline/Pubmed, Embase/Ovid, CINAHL/EBSCO and Google Scholar up to October 2018.Study selectionStudies that assessed CDRs for intermittent-type chest pain and for rule out of acute coronary syndrome (ACS) applicable in general practice, thus not relying on advanced laboratory, computer or diagnostic testing.Review methodsReviewers identified studies, extracted data and assessed the quality of the evidence (using Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2)), independently and in duplicate.ResultsEight studies comprising five CDRs met the inclusion criteria. Three CDRs are designed for rule out of coronary disease in intermittent-type chest pain (Gencer rule, Marburg Heart Score, INTERCHEST), and two for rule out of ACS (Grijseels rule, Bruins Slot rule). Studies that examined the Marburg Heart Score had the highest methodological quality with consistent sensitivity (86%–91%), specificity (61%–81%) and positive (23%–35%) and negative (97%–98%) predictive values (PPV and NPV). The diagnostic performance of Gencer (PPV: 20%–34%, NPV: 95%–99%) and INTERCHEST (PPV: 35%–43%, NPV: 96%–98%) appear comparable, but requires further validation. The Marburg Heart Score was more sensitive in detecting coronary disease than the clinical judgement of the general practitioner. The performance of CDRs that focused on rule out of ACS were: Grijseels rule (sensitivity: 91%, specificity: 37%, PPV: 57%, NPV: 82%) and Bruins Slot (sensitivity: 97%, specificity: 10%, PPV: 23%, NPV: 92%). Compared with clinical judgement, the Bruins Slot rule appeared to be safer than clinical judgement alone, but the study was limited in sample size.ConclusionsIn general practice, there is currently no clinical decision aid that can safely rule out ACS. For intermittent chest pain, several rules exist, of which the Marburg Heart Score has been most extensively tested and appears to outperform clinical judgement alone.

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Pre-hospital risk assessment in suspected non-ST-elevation acute coronary syndrome: A prospective observational study

European Heart Journal Acute Cardiovascular Care ◽

10.1177/2048872618813846 ◽

2018 ◽

Vol 9 (1_suppl) ◽

pp. 5-12 ◽

Cited By ~ 12

Author(s):

Dominique N van Dongen ◽

Rudolf T Tolsma ◽

Marion J Fokkert ◽

Erik A Badings ◽

Aize van der Sluis ◽

...

Keyword(s):

Myocardial Infarction ◽

High Risk ◽

Risk Stratification ◽

Risk Group ◽

High Risk Group ◽

Low Risk ◽

Heart Score ◽

Coronary Syndrome ◽

Risk Patients ◽

St Elevation

Background: Pre-hospital risk stratification of non-ST-elevation acute coronary syndrome (NSTE-ACS) by the complete HEART score has not yet been assessed. We investigated whether pre-hospital risk stratification of patients with suspected NSTE-ACS using the HEART score is accurate in predicting major adverse cardiac events (MACE). Methods: This is a prospective observational study, including 700 patients with suspected NSTE-ACS. Risk stratification was performed by ambulance paramedics, using the HEART score; low risk was defined as HEART score ⩽ 3. Primary endpoint was occurrence of MACE within 45 days after inclusion. Secondary endpoint was myocardial infarction or death. Results: A total of 172 patients (24.6%) were stratified as low risk and 528 patients (75.4%) as intermediate to high risk. Mean age was 53.9 years in the low risk group and 66.7 years in the intermediate to high risk group ( p<0.001), 50% were male in the low risk group versus 60% in the intermediate to high risk group ( p=0.026). MACE occurred in five patients in the low risk group (2.9%) and in 111 (21.0%) patients at intermediate or high risk ( p<0.001). There were no deaths in the low risk group and the occurrence of acute myocardial infarction in this group was 1.2%. In the high risk group six patients died (1.1%) and 76 patients had myocardial infarction (14.4%). Conclusions: In suspected NSTE-ACS, pre-hospital risk stratification by ambulance paramedics, including troponin measurement, is accurate in differentiating between low and intermediate to high risk. Future studies should investigate whether transportation of low risk patients to a hospital can be avoided, and whether high risk patients benefit from immediate transfer to a hospital with early coronary angiography possibilities.

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