Decision Aids for Low-Risk Chest Pain

Patients with “low-risk” chest pain consume enormous resources with extremely low yield from observation and testing such as exercise tolerance testing. Decision aids could be useful in such cases; however, neither the Thrombolysis in Myocardial Infarction (TIMI) score nor the HEART score is sufficiently sensitive to predict 30-day cardiac events (missing 2% to 3% of such events). Both scores consider symptoms, age, risk factors, and electrocardiogram findings, and the HEART score also incorporates troponin testing.

To determine whether combining the scores would further risk stratify patients, researchers retrospectively calculated the HEART score for a cohort of 9000 patients who had TIMI scores calculated as part of their evaluation for p…