Have a HEART
Use of the HEART score to risk stratify chest pain patients was undertaken in 9 Dutch hospitals. This was a cluster randomized trial. Major adverse coronary events occurred in 2% of patients with a low risk HEART score. Nonadherence to early discharge in patients classified as low risk was 41%. This was likely due to the newness of the score at the time, which may have made physicians uncertain of its safety.
The HEART score is one safe way to help risk stratify chest pain patients. For more on HEART and other scoring systems, see Amal Mattu’s algorithmic approach in the module he wrote for Evidence Care.
Ali Raja had an insightful review on NEJM Journal Watch, and EMLoN also had a good take on this article.
Effect of Using the HEART Score in Patients With Chest Pain in the Emergency Department: A Stepped-Wedge, Cluster Randomized Trial. Ann Intern Med. 2017 May 16;166(10):689-697. doi: 10.7326/M16-1600. Epub 2017 Apr 25.