Can the HEART score safely reduce stress testing and cardiac imaging in patients at low risk for major adverse cardiac events?

Critical Pathways in Cardiology

Volumn 10, Issue 3, 2011, Pages 128-133

  Mahler, Simon A ^a   Hiestand, Brian C ^a   Goff Jr , David C ^a   Hoekstra, James W ^a   Miller, Chadwick D ^a  

^a WAKE FOREST SCHOOL OF MEDICINE   (United States)

Author keywords

cardiac testing; chest pain; HEART score; observation; risk stratification

Indexed keywords

TROPONIN;

ADULT; AGED; CARDIAC IMAGING; CARDIOVASCULAR RISK; DISEASE REGISTRY; EMERGENCY WARD; FEMALE; HEART INFARCTION; HEART MUSCLE REVASCULARIZATION; HEART SCORE; HUMAN; MAJOR CLINICAL STUDY; MALE; MEDICAL RECORD REVIEW; MORTALITY; OUTCOME ASSESSMENT; PRIORITY JOURNAL; REVIEW; RISK ASSESSMENT; SCORING SYSTEM; SENSITIVITY AND SPECIFICITY; STRESS; THORAX PAIN;

ACUTE CORONARY SYNDROME; AGED; CARDIAC IMAGING TECHNIQUES; CHEST PAIN; CONFIDENCE INTERVALS; CORONARY CARE UNITS; CROSS-SECTIONAL STUDIES; DIAGNOSIS, DIFFERENTIAL; ELECTROCARDIOGRAPHY; EXERCISE TEST; FEMALE; FOLLOW-UP STUDIES; HUMANS; INCIDENCE; MALE; MIDDLE AGED; ODDS RATIO; PROGNOSIS; REPRODUCIBILITY OF RESULTS; RETROSPECTIVE STUDIES; RISK ASSESSMENT; RISK FACTORS;

EID: 80053394975     PISSN: 1535282X     EISSN: 15352811     Source Type: Journal    
DOI: 10.1097/HPC.0b013e3182315a85     Document Type: Review

References (17)

1. Owens PL, Barrett ML, Gibson TB, et al. Emergency department care in the United States: A profile of national data sources. Ann Emerg Med. 2010;56:150-165.
2. Pope JH, Aufderheide TP, Ruthazer R, et al. Missed diagnoses of acute cardiac ischemia in the emergency department. N Engl J Med. 2000;342:1163-1170. (Pubitemid 30211047)
3. Pines JM, Isserman JA, Szyld D, et al. The effect of physician risk tolerance and the presence of an observation unit on decision making for ED patients with chest pain. Am J Emerg Med. 2010;28:771-779.
4. Fleischmann KE, Goldman L, Johnson PA, et al. Critical pathways for patients with acute chest pain at low risk. J Thromb Thrombolysis. 2002;13:89-96.
5. Roger VL, Go AS, Lloyd-Jones DM, et al. Heart disease and stroke statistics- 2011 update: A report from the American Heart Association. Circulation. 2011;123:e18-e209.
6. Chan GW, Sites FD, Shofer FS, et al. Impact of stress testing on 30-day cardiovascular outcomes for low-risk patients with chest pain admitted to floor telemetry beds. Am J Emerg Med. 2003;21:282-287. (Pubitemid 36959128)
7. Hermann LK, Weingart SD, Duvall WL, et al. The limited utility of routine cardiac stress testing in emergency department chest pain patients younger than 40 years. Ann Emerg Med. 2009;54:12-16.
8. Lyon R, Morris AC, Caesar D, et al. Chest pain presenting to the emergency department-to stratify risk with GRACE or TIMI? Resuscitation. 2007;74:90-93. (Pubitemid 46900983)
9. O'Connor RE, Bossaert L, Arntz HR, et al. Part 9: Acute coronary syndromes: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation. 2010;122:S422-S465.
10. Six AJ, Backus BE, Kelder JC. Chest pain in the emergency room: Value of the HEART score. Neth Heart J. 2008;16:191-196.
11. Backus BE, Six AJ, Kelder JC, et al. Chest pain in the emergency room: A multicenter validation of the HEART Score. Crit Pathw Cardiol. 2010;9: 164-169.
12. Kline JA, Courtney DM, Kabrhel C, et al. Prospective multicenter evaluation of the pulmonary embolism rule-out criteria. J Thromb Haemost. 2008;6: 772-780. (Pubitemid 351524537)
13. Anderson JL, Adams CD, Antman EM, et al. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction) developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine. J Am Coll Cardiol. 2007;50:e1-e157.
14. Alpert JS, Thygesen K, Antman E, et al. Myocardial infarction redefined-a consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction. J Am Coll Cardiol. 2000;36:959-969.
15. CDC. United States Obesity Trends. Trends by State 1985-2009. Available at http://www.cdc.gov/obesity/data/trends.html. Accessed February 15, 2011.
16. Takakuwa KM, Halpern EJ, Shofer FS. A time and imaging cost analysis of low-risk ED observation patients: A conservative 64-section computed tomography coronary angiography "triple rule-out" compared to nuclear stress test strategy. Am J Emerg Med. 2011;29:187-195.
17. Amsterdam EA, Kirk JD, Bluemke DA, et al. Testing of low-risk patients presenting to the emergency department with chest pain: A scientific statement from the American Heart Association. Circulation. 2010;122:1756-1776.