ArticleInternal and emergency medicine2018
An external validation of the HEART pathway among Emergency Department patients with chest pain.
Article in Internal and emergency medicine, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 1 of them a synthesis that pooled it.
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Who cites it
13 citing papers in PubMed, 1 synthesis or guideline pooled it, 23 citations in OpenAlex.
- A meta-analysis on the safety and accuracy of the HEART pathway for risk stratification in patients with acute chest pain.BMC cardiovascular disorders · 2025Pooled it
- Time-stratified HEART score discrimination and calibration in emergency chest pain: a retrospective cohort study.BMC emergency medicine · 2026Article
- Modified HEART score to improve ruling out acute coronary syndrome at the emergency department.Internal and emergency medicine · 2026Article
- Performance of the HEART Score in pre-hospital settings for suspected non-ST-elevation acute coronary syndrome: The POPular HEART Study.Netherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation · 2026Article
- Evaluating the Efficacy of CPS, HEART and TIMI Score in Emergency Department Patients with Non-Traumatic Chest Pain: A Pilot Study.Medical sciences (Basel, Switzerland) · 2026Article
- Modification of HEART Pathway for Patients With Chest Pain: A Korean Perspective.Korean circulation journal · 2023Article
- Diagnostic Impact of Hs-CRP and IL-6 for Acute Coronary Syndrome in Patients Admitted to the ED with Chest Pain: Added Value to the HEART Score?Open access emergency medicine : OAEM · 2023Article
- Interrater agreement of the HEART score history component: A chart review study.Journal of the American College of Emergency Physicians open · 2022Article
- Validation and modification of HEART score components for patients with chest pain in the emergency department.Clinical and experimental emergency medicine · 2021Article
- A Prospective Evaluation of Clinical HEART Score Agreement, Accuracy, and Adherence in Emergency Department Chest Pain Patients.Annals of emergency medicine · 2021Observational
- Article
- The HEART score as a prognostic tool for revascularization.Internal and emergency medicine · 2020Article
- Do all HEART Scores beat the same: evaluating the interoperator reliability of the HEART Score.Emergency medicine journal : EMJ · 2018Article
Corrections and comments
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Authors and funding
8 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
The impact of an outpatient disposition strategy for patients with HEART score 0-3 (HEART pathway) on HEART score prognostic accuracy is unclear. Our objective is to perform an external validation the HEART score in the setting of recent implementation of the HEART pathway. We conducted an external validation study of the HEART pathway among patients presenting to our ED with chest pain 6 weeks after institutional implementation of a HEART pathway outpatient disposition pathway. We reviewed the charts of 625 consecutive patients with chest pain. Data abstracted included all elements of the HEART score to include history, electrocardiogram (ECG) read, patient age, patient risk factors, and troponin levels. We also reviewed each patient's record for evidence of major adverse cardiac events (MACE) to include mortality, myocardial infarction, or coronary revascularization over 6 weeks following their initial ED visit. We double-abstracted 10% of the charts for quality assurance purposes. Of 625 charts, 449 patients met all criteria for study inclusion. Of these, 25 subjects (5.56%) experience 6-week MACE. No subject with a score of 3 or less has a MACE at 6 weeks (100% sensitivity, 38.7% specificity). The area under the receiver operator curve (AUROC) is 0.898 (95% confidence interval 0.847-0.950). Kappa coefficients for inter-rater reliability range from 0.62 for the history component of the HEART score to 1.0 for troponin. A low HEART score (0-3) maintains excellent sensitivity for predicting 6-week MACE in the setting of an outpatient disposition pathway for these patients.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.