Observational studyAnnals of emergency medicine2021
A Prospective Evaluation of Clinical HEART Score Agreement, Accuracy, and Adherence in Emergency Department Chest Pain Patients.
Observational study in Annals of emergency medicine, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
15 citing papers in PubMed, 23 citations in OpenAlex.
- Hospital Admission Despite Low-Risk History, Electrocardiogram, Age, Risk factors, and Troponin (HEART) Scores and 30-Day Outcomes in Emergency Department Chest Pain.Journal of the American College of Emergency Physicians open · 2026Article
- Time-stratified HEART score discrimination and calibration in emergency chest pain: a retrospective cohort study.BMC emergency medicine · 2026Article
- Clinical outcomes of chest pain with cocaine use: a propensity score-matched analysis.Internal and emergency medicine · 2025Article
- Article
- HEART Score Agreement Between Attending and Resident Emergency Medicine Physicians for Patients With Potential Acute Coronary Syndrome.Ochsner journal · 2025Article
- Performance of computerized self-reported medical history taking and HEAR score for safe early rule-out of cardiac events in acute chest pain patients: the CLEOS-CPDS prospective cohort study.European heart journal. Digital health · 2025Article
- Characteristics and Outcomes of Patients With a Moderate History, ECG, Age, Risk Factors, and Troponin (HEART) Score.Cureus · 2024Article
- Cardiac Troponin Levels in Patients with Chronic Kidney Disease: "Markers of High Risk or Just Noise''?Diagnostics (Basel, Switzerland) · 2024Review
- Frequency, compliance, and yield of cardiac testing after high-sensitivity troponin accelerated diagnostic protocol implementation.The American journal of emergency medicine · 2023Article
- HEART versus GRACE Score in Predicting the Outcomes of Patients with Acute Coronary Syndrome; a Systematic Review and Meta-Analysis.Archives of academic emergency medicine · 2023Review
- Transfer learning enables prediction of myocardial injury from continuous single-lead electrocardiography.Journal of the American Medical Informatics Association : JAMIA · 2022Article
- A Closer Look at the HEART Score.Cardiology research · 2022Review
- SVEAT score outperforms HEART score in patients admitted to a chest pain observation unit.World journal of cardiology · 2022Article
- Interrater agreement of the HEART score history component: A chart review study.Journal of the American College of Emergency Physicians open · 2022Article
- Artificial intelligence and machine learning in emergency medicine: a narrative review.Acute medicine & surgeryReview
Corrections and comments
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Authors and funding
8 authors at 4 institutions in 1 country.
Funding
Abstract
STUDY
objectiveThe HEART score is a risk stratification aid that may safely reduce chest pain admissions for emergency department patients. However, differences in interpretation of subjective components potentially alters the performance of the score. We compared agreement between HEART scores determined during clinical practice with research-generated scores and estimated their accuracy in predicting 30-day major adverse cardiac events.
methodsWe prospectively enrolled adult ED patients with symptoms concerning for acute coronary syndrome at a single tertiary center. ED clinicians submitted their clinical HEART scores during the patient encounter. Researchers then independently interviewed patients to generate a research HEART score. Patients were followed by phone and chart review for major adverse cardiac events. Weighted kappa; unweighted Cohen's kappa; prevalence-adjusted, bias-adjusted kappa (PABAK); and test probabilities were calculated.
resultsFrom November 2016 to June 2019, 336 patients were enrolled, 261 (77.7%) were admitted, and 30 (8.9%) had major adverse cardiac events. Dichotomized HEART score agreement was 78% (kappa 0.48, 95% confidence interval [CI] 0.37 to 0.58; PABAK 0.57, 95% CI 0.48 to 0.65) with the lowest agreement in the history (72%; WK 0.14, 95% CI 0.06 to 0.22) and electrocardiogram (85%; WK 0.4, 95% CI 0.3 to 0.49) components. Compared with researchers, clinicians had 100% sensitivity (95% CI 88.4% to 100%) (versus 86.7%, 95% CI 69.3% to 96.2%) and 27.8% specificity (95% CI 22.8% to 33.2%) (versus 34.6%, 95% CI 29.3% to 40.3%) for major adverse cardiac events. Four participants with low research HEART scores had major adverse cardiac events.
conclusionED clinicians had only moderate agreement with research HEART scores. Combined with uncertainties regarding accuracy in predicting major adverse cardiac events, we urge caution in the widespread use of the HEART score as the sole determinant of ED disposition.
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