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- Title
Prehospital Modified HEART Score Predictive of 30-Day Adverse Cardiac Events.
- Authors
Stopyra, Jason P.; Harper, William S.; Higgins, Tyson J.; Prokesova, Julia V.; Winslow, James E.; Nelson, Robert D.; Alson, Roy L.; Davis, Christopher A.; Russell, Gregory B.; Miller, Chadwick D.; Mahler, Simon A.
- Abstract
Introduction The History, Electrocardiogram (ECG), Age, Risk Factors, and Troponin (HEART) score is a decision aid designed to risk stratify emergency department (ED) patients with acute chest pain. It has been validated for ED use, but it has yet to be evaluated in a prehospital setting. Hypothesis A prehospital modified HEART score can predict major adverse cardiac events (MACE) among undifferentiated chest pain patients transported to the ED.<bold>Methods: </bold>A retrospective cohort study of patients with chest pain transported by two county-based Emergency Medical Service (EMS) agencies to a tertiary care center was conducted. Adults without ST-elevation myocardial infarction (STEMI) were included. Inter-facility transfers and those without a prehospital 12-lead ECG or an ED troponin measurement were excluded. Modified HEART scores were calculated by study investigators using a standardized data collection tool for each patient. All MACE (death, myocardial infarction [MI], or coronary revascularization) were determined by record review at 30 days. The sensitivity and negative predictive values (NPVs) for MACE at 30 days were calculated.<bold>Results: </bold>Over the study period, 794 patients met inclusion criteria. A MACE at 30 days was present in 10.7% (85/794) of patients with 12 deaths (1.5%), 66 MIs (8.3%), and 12 coronary revascularizations without MI (1.5%). The modified HEART score identified 33.2% (264/794) of patients as low risk. Among low-risk patients, 1.9% (5/264) had MACE (two MIs and three revascularizations without MI). The sensitivity and NPV for 30-day MACE was 94.1% (95% CI, 86.8-98.1) and 98.1% (95% CI, 95.6-99.4), respectively.<bold>Conclusions: </bold>Prehospital modified HEART scores have a high NPV for MACE at 30 days. A study in which prehospital providers prospectively apply this decision aid is warranted. Stopyra JP , Harper WS , Higgins TJ , Prokesova JV , Winslow JE , Nelson RD , Alson RL , Davis CA , Russell GB , Miller CD , Mahler SA . Prehospital modified HEART score predictive of 30-day adverse cardiac events. Prehosp Disaster Med. 2018;33(1):58-62.
- Subjects
UNITED States; ADVERSE health care events; PREVENTION of heart diseases; ELECTROCARDIOGRAPHY; MYOCARDIAL revascularization; CHEST pain; EMERGENCY medical services; PATIENTS; CHEST pain diagnosis; CHEST pain treatment; MYOCARDIAL infarction diagnosis; MYOCARDIAL infarction-related mortality; MYOCARDIAL infarction treatment; TREATMENT of acute coronary syndrome; HOSPITAL emergency services; LONGITUDINAL method; RESEARCH funding; RISK assessment; SURVIVAL; TIME; PREDICTIVE tests; RETROSPECTIVE studies; SEVERITY of illness index; ACUTE coronary syndrome; TROPONIN; DIAGNOSIS
- Publication
California English, 2018, Vol 23, Issue 3, p58
- ISSN
0008-1035
- Publication type
journal article
- DOI
10.1017/S1049023X17007154