Spotlight on Research

The History, Electrocardiogram (ECG), Age, Risk factors and Troponin (HEART) score is widely used in emergency departments to categorise risk in patients with chest pain that is suspicious for a myocardial infarction, and to help identify those at low risk who are appropriate for early discharge. Studies in the prehospital environment have evaluated the low-risk HEART score using a point-of-care troponin assay but have not demonstrated the sensitivity and negative predictive value (NPV) to safely identify patients who could be managed without hospital transfer.

This study undertook secondary analysis of data collected in an earlier prospective cohort study to try to identify lower-risk patients who could be managed outside hospital. Data were originally collected in the Ambulance Cardiac Chest Pain Evaluation in Scotland Study (ACCESS), where paramedics prospectively enrolled patients with suspected acute coronary syndrome without diagnostic ST-segment elevation on the ECG. A HEAR (without Troponin) score was recorded contemporaneously, and a prehospital blood sample was obtained for subsequent cardiac troponin testing. Troponin was tested at the emergency department using the Siemens ADVIA Centaur Ultra contemporary cardiac troponin I assay, and surplus blood was sent for analysis with Abbott ARCHITECT high-sensitivity troponin I assay. The prehospital HEART score was calculated separately for both the contemporary and high-sensitivity cardiac troponin assays. The primary outcome measure was Major Adverse Cardiac Events (MACE) at 30 days (as defined in the study). A HEART score of ≤3 and ≥7 represented low- and high-risk, respectively (see article for calculation of HEART score).