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The HEART (history, electrocardiogram, age, risk factors, initial troponin) score has been shown to be safe and effective for risk stratification of patients with potential acute myocardial infarction (NEJM JW Emerg Med Jun 2017 and Ann Intern Med 2017; 166:689). However, as with many clinical decision rules, some of its components are subjective (e.g., electrocardiogram [ECG] interpretation, whether the patient's history is suggestive of acute coronary syndrome [ACS]). This subjectivity may lead to interrater variability, which is especially concerning given the incorporation of the HEART score into emergency department risk stratification protocols (NEJM JW Emerg Med Oct 2018 and Circulation 2018; 138:2061).
These researchers conducted a p…