The Effectiveness of Using the HEART Score on Patients Complaining of Chest Pain in The Emergency Department Who Are at Risk of Acute Coronary Syndrome: a systematic review.
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Date
2023-07-18
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Saudi Digital Library
Abstract
Background: Chest pain is one of the most common causes of presentation to the emergency room. The diagnosis of non-ST-elevation acute coronary syndrome is a challenge because this condition doesn't have an easily identifiable electrical pattern like the other main types of heart attacks. The HEART Pathway (history, ECG, age, risk factors, and troponin) is a rapid diagnostic tool that identifies low-risk emergency department patients with chest pain for early discharge without stress testing or angiography.
Aim: This systematic review aims to Determine the effectiveness of the HEART score in patients with chest pain who might be suspected of acute coronary syndrome in the Emergency Department.
Methodology: Five electronic databases (CHINAL, Medline, PubMed, Cochrane Library, and Web of Science) were searched systematically. A systematic search strategy was formulated with the assistance of an expert librarian. The appraisal tools that are used by RevMan and the Joanna Briggs Institute (JBI) for systematic reviews assess the quality of each study.
Results: A total of seven studies are included. Five of the studies were randomised trials; one was quasi-experimental; and the last was an observational cohort study. They looked at the effectiveness of the HEART score to identify low-risk patients who can be safely discharged without stress testing or angiography in the emergency department. Five studies support the implementation of the HEART Pathway, but one caution against the widespread use of the HEART score as the sole determinant of ED disposition, and one study shows that the HEART score was incorrectly calculated for patients, leading to inappropriate risk categorization. Therefore, actions should be taken to improve the score’s use in daily practice. The discussion was based on the HEART Score, and the included studies relate to institutional policy, education, clinical decision-making, and continuing professional development.
Conclusions
The HEART Pathway reduces objective cardiac testing, shortens stay length, and increases early discharges without major adverse cardiovascular events at 30 days. It supports identifying low-risk patients who can be safely discharged without stress testing or angiography. However, this systematic review found that caution is advised when using the HEART score alone as a standard of care for ED patients with chest pain, as it may be calculated incorrectly.
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Keywords
HEART score, HEART pathway, Acute Coronary Syndrome, Chest Pain, Emergency Department, Risk Assessment