II. Indications

  1. Chest Pain risk stratification in the emergency department

III. Criteria

  1. History
    1. Score 2: History highly suspicious for coronary syndrome
    2. Score 1: History moderately suspicious for coronary syndrome
    3. Score 0: History slightly suspicious for coronary syndrome
  2. Electrocardiogram (EKG)
    1. Score 2: EKG with Significant ST Depression
    2. Score 1: EKG with Non-specific repolarization disturbance
    3. Score 0: EKG Normal
  3. Age
    1. Score 2: Age 65 years or older
    2. Score 1: Age 45 to 65 years old
    3. Score 0: Age <45 years old
  4. Risk Factors
    1. Score 2: Three or more risk factors for or history of atherosclerotic disease
    2. Score 1: One to 2 risk factors for atherosclerotic disease
    3. Score 0: No risk factors for atherosclerotic disease
  5. Troponin
    1. Score 2: More than twice the normal Troponin upper limit
    2. Score 1: One to 2 times the normal Troponin upper limit
    3. Score 0: Within normal limits for Troponin levels

IV. Interpretation: Based on sum of 5 criteria above (of total possible points 10)

  1. Total Score 0-3
    1. Adverse outcome risk: 2.5% (very low to low risk)
    2. Supports early discharge with appropriate follow-up
  2. Total Score 4-6
    1. Adverse outcome risk: 20.3% (moderate risk)
    2. Supports admission with standard rule-out management (serial Troponins) and stress testing
  3. Total Score 7-10
    1. Adverse outcome risk: 72.7% (high to very high risk)
    2. Risk in first 30 days >50%
    3. Supports early aggressive management and typically with cardiac catheterization

V. Efficacy

  1. Allows for meaningful risk stratification of Low Risk Chest Pain
    1. Identifies 36% of Low Risk Chest Pain patients as lower risk for adverse event (HEART Score 0-3)
    2. Contrast with TIMI Score which only risk stratified 5% of the same low risk patients
    3. Identifies high risk patients (HEART Score >6) who have a >50% risk of adverse event in the next 30 days
  2. References
    1. Swadron and Mallon in Herbert (2015) EM:Rap 15(12): 11-2
    2. Bachus (2013) Int J Cardiol 168(3): 2153-8 +PMID: 23465250 [PubMed]

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