ArticleCureus2025
Elevated Major Adverse Cardiac Event (MACE) Risk With a HEART Score of 3: A Single-Site Retrospective Validation Study.
Article in Cureus, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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.
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Who cites it
1 citing paper in PubMed.
- 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
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Authors and funding
10 authors.
Funding
Abstract
objectiveThe HEART pathway is a widely used clinical decision-making tool to risk-stratify patients presenting with chest pain in the emergency department (ED). A HEART score of 0-3 is generally accepted as "low risk," often serving as a threshold for safe discharge. This study aimed to evaluate the performance of the HEART pathway in an urban academic ED and determine the associated rate of major adverse cardiac events (MACE) at a HEART score of 3. MACE were defined as all-cause mortality, cardiovascular death, myocardial infarction, heart failure hospitalization, or stroke within 90 days.
methodsWe conducted a retrospective chart review of 1,284 ED visits for chest pain from September 1, 2017, to August 31, 2018, at Louisiana State University Health Shreveport (LSUHS), Shreveport, Louisiana. HEART scores, demographics, and 90-day MACE outcomes were collected and analyzed using non-parametric statistical methods.
resultsOf 1,284 patients, 79 (6.2%) experienced MACE. Among patients with a HEART score of 3 or less, the MACE rate was 4.4% using Wilcoxon's rank-sum test (p < 0.001). The HEART score showed a positive correlation with MACE using Spearman's rank correlation coefficient (ρ = 0.223, p < 0.001). Age correlated moderately with the HEART score (ρ = 0.568), but not with MACE. Gender showed no significant correlation with either HEART score or MACE outcomes.
conclusionA HEART score of 3 was associated with a MACE rate higher than the traditionally accepted 2% threshold for low risk. Clinicians should approach disposition decisions for these patients with caution and consider shared decision-making and observation. Further research is needed to refine HEART score interpretation at this critical threshold.
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