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Monday, March 22, 2021

The HEAR Score


REBEL EM - March 22, 2021 - By Jonathan Gravel
Article: Smith LM et al. Identification of very low-risk acute chest pain patients without troponin testing. Emerg Med J 2020. PMID: 32753395.
“Clinical Question: When using the HEART Pathway to risk stratify patients, is there a group of very low-risk chest pain patients (HEAR score ≤ 1) that does not require troponin testing to achieve a MACE miss rate <1%?
Author Conclusion: These data suggest that patients with HEAR scores of 0 and 1 represent a very low-risk group that may not require troponin testing to achieve a missed MACE rate <1%”
Clinical Take Home Point: Using a HEAR score ≤1 without troponin testing to safely disposition patients is certainly interesting, has face validity, and worth validating. However, with 95% CI crossing >2% for MACE at 30d, I am not sure we are at a place where potentially missing this many events would be considered standard care or even safe from a medicolegal perspective.”