Cardiovascular Medicine Book

Vitals

Dermatology

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HEART Score

Aka: HEART Score
  1. See Also
    1. Chest Pain
    2. Acute Chest Pain
    3. Angina Diagnosis
    4. Cardiac Risk Assessment
    5. Cardiac Risk Management
    6. Coronary Risk Stratification of Chest Pain
    7. TIMI Risk Score
    8. Bosner Chest Pain Decision Rule
    9. Cardiac Risk in Diabetes Score
    10. Chest Wall Pain Prediction Rule
    11. Framingham Score
    12. Cardiac Risk in Diabetes Score
    13. GRACE Score
    14. Vancouver Chest Pain Rule
  2. Indications
    1. Chest Pain risk stratification in the emergency department
  3. 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
  4. 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
  5. 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]
  6. References
    1. Six (2008) Neth Heart J 16(6):191-6 [PubMed]

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