HEART Score for Chest Pain in ED Found to Be Safe, Cost-Effective

By Amy Orciari Herman

Edited by David G. Fairchild, MD, MPH

A simple cardiac score can safely risk-stratify patients presenting to the emergency department with chest pain — and may lead to substantial cost-savings — suggests an Annals of Internal Medicine study.

After a period of usual care, nine Dutch hospitals switched — in randomized order — to using the HEART score, which incorporates the patient's History, Electrocardiogram findings, Age, Risk factors, and Troponin measurement. The score was used to decide on further management. For example, a score of 3 or less (out of a possible 10) called for discharge without further testing. Over 3600 adults without evident ST-segment elevation MI were included.

HEART care was noninferior to usual care in terms of the primary safety outcome — incidence of major adverse cardiovascular events at 6 weeks (19% and 22%, respectively). Use of healthcare resources was similar between groups, but a cost-effectiveness analysis suggested that the HEART score could save 40 million (>$US 40 million) annually in the Netherlands.

Dr. Ali Raja of NEJM Journal Watch Emergency Medicine commented: "I personally pull up the HEART score every shift to guide my shared decision-making with my low-risk patients, and believe that it has an acceptable miss rate."