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Prehospital Modified HEART Score Predictive of 30-Day Adverse Cardiac Events

Abstract
Introduction

The History, Electrocardiogram (ECG), Age, Risk Factors, and Troponin (HEART) score is a decision aid designed to risk stratify emergency department (ED) patients with acute chest pain. It has been validated for ED use, but it has yet to be evaluated in a prehospital setting.

Hypothesis

A prehospital modified HEART score can predict major adverse cardiac events (MACE) among undifferentiated chest pain patients transported to the ED.

Methods

A retrospective cohort study of patients with chest pain transported by two county-based Emergency Medical Service (EMS) agencies to a tertiary care center was conducted. Adults without ST-elevation myocardial infarction (STEMI) were included. Inter-facility transfers and those without a prehospital 12-lead ECG or an ED troponin measurement were excluded. Modified HEART scores were calculated by study investigators using a standardized data collection tool for each patient. All MACE (death, myocardial infarction [MI], or coronary revascularization) were determined by record review at 30 days. The sensitivity and negative predictive values (NPVs) for MACE at 30 days were calculated.

Results

Over the study period, 794 patients met inclusion criteria. A MACE at 30 days was present in 10.7% (85/794) of patients with 12 deaths (1.5%), 66 MIs (8.3%), and 12 coronary revascularizations without MI (1.5%). The modified HEART score identified 33.2% (264/794) of patients as low risk. Among low-risk patients, 1.9% (5/264) had MACE (two MIs and three revascularizations without MI). The sensitivity and NPV for 30-day MACE was 94.1% (95% CI, 86.8-98.1) and 98.1% (95% CI, 95.6-99.4), respectively.

Conclusions

Prehospital modified HEART scores have a high NPV for MACE at 30 days. A study in which prehospital providers prospectively apply this decision aid is warranted.

Stopyra JP , Harper WS , Higgins TJ , Prokesova JV , Winslow JE , Nelson RD , Alson RL , Davis CA , Russell GB , Miller CD , Mahler SA . Prehospital Modified HEART Score Predictive of 30-Day Adverse Cardiac Events. Prehosp Disaster Med. 2018;33(1):5862.

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Copyright
Corresponding author
Correspondence: Jason P. Stopyra, MD Department of Emergency Medicine Wake Forest School of Medicine Medical Center Boulevard Winston-Salem, North Carolina 27157 USA E-mail: jstopyra@wakehealth.edu
Footnotes
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Conflicts of interest/funding: This study was funded by the American Heart Association (Dallas, Texas USA; 12CRP12000001). Dr. Mahler receives funding from the Donaghue Foundation (West Hartford, Connecticut USA), Duke Endowment (Charlotte, North Carolina USA), Abbott Point of Care (Princeton, New Jersey USA), Roche Diagnostics (Indianapolis, Indiana USA), and the National Heart, Lung, and Blood Institute (NHLBI; Bethesda, Maryland USA; 1 R01 HL118263-01, L30 HL120008). Dr. Mahler is the chief medical officer for Decision Point Informatics (Raleigh, North Carolina USA). Dr. Stopyra receives funding from Abbott Point of Care.

Footnotes
References
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Prehospital and Disaster Medicine
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Keywords

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acute coronary syndrome
  • acute myocardial infarction
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    acute myocardial infarction
  • electrocardiogram
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    electrocardiogram
  • emergency department
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    emergency department
  • Emergency Medical Services
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    Emergency Medical Services
  • History, ECG, Age, Risk Factors
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    History, ECG, Age, Risk Factors
  • History, ECG, Age, Risk Factors, and Troponin
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    History, ECG, Age, Risk Factors, and Troponin
  • major adverse cardiac events
  • " class="button small radius grey keywords">
    major adverse cardiac events
  • myocardial infarction" class="button small radius grey keywords">
    myocardial infarction
  • negative predictive value" class="button small radius grey keywords">
    negative predictive value
  • point-of-care" class="button small radius grey keywords">
    point-of-care
  • ST-elevation myocardial infarction" class="button small radius grey keywords">
    ST-elevation myocardial infarction
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