Article Text

other Versions

PDF
HEART score and clinical gestalt have similar diagnostic accuracy for diagnosing ACS in an unselected population of patients with chest pain presenting in the ED
  1. Anniek Visser1,
  2. Albert Wolthuis2,
  3. Rob Breedveld3,
  4. Ewoud ter Avest1
  1. 1Department of Emergency Medicine, Medical Center Leeuwarden, Leeuwarden, The Netherlands
  2. 2Department of Clinical Chemistry, Medical Center Leeuwarden, Leeuwarden, The Netherlands
  3. 3Department of Cardiology, Medical Center Leeuwarden, Leeuwarden, The Netherlands
  1. Correspondence to Dr Ewoud ter Avest, Department of Emergency Medicine, Medical Center Leeuwarden, Henri Dunantweg 2, Leeuwarden 8934 AD, The Netherlands; teravestewoud{at}hotmail.com

Abstract

Background Acute coronary syndrome (ACS) can be a diagnostic challenge in the emergency department (ED). Recently, the HEART score was developed, a simple bedside scoring system that quantifies risk of ischaemic events in patients with undifferentiated chest pain presenting in the ED.

Objective In this prospective cohort study, we compared the diagnostic accuracy of HEART score and clinical gestalt (clinical judgement) for diagnosing ACS in an unselected population of patients with chest pain presenting to the ED.

Methods HEART score (0–10) and clinical gestalt (low risk, intermediate risk or high risk of ACS) were prospectively determined in the ED in 255 patients presenting with chest pain by the treating physician. The reference standard was the presence of ACS, which was defined as either acute myocardial infarction (AMI) or the occurrence of a major adverse cardiac event within 6 weeks after presentation in the ED.

Results 75 out of 255 patients (29%) had an ACS. A HEART score ≤3 had a lower negative likelihood ratio (0.15 (0.06–0.36)) for ACS than a low risk based on clinical gestalt (0.35 (0.19–0.64)), whereas a high HEART score ≥7 had a higher positive likelihood ratio (5.2 (3.2–8.5) vs 3.1 (2.2–4.4)). However, c-statistic of HEART score was not significantly different from clinical gestalt (0.81 (0.76–0.86) vs 0.79 (0.73–0.84), p=0.13).

Conclusions Our study demonstrates that HEART score and clinical gestalt have similar diagnostic accuracy for diagnosing ACS in an unselected population of patients with chest pain presenting in the ED.

  • acute coronary syndrome
  • cardiac care, diagnosis
  • chest
  • clinical assessment
  • cardiac care, acute coronary syndrome

Statistics from Altmetric.com

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.