Prehospital Modified HEART Score Predictive of 30-Day Adverse Cardiac Events.
Prehosp Disaster Med
; 33(1): 58-62, 2018 Feb.
Article
en En
| MEDLINE
| ID: mdl-29316995
ABSTRACT
Introduction The History, Electrocardiogram (ECG), Age, Risk Factors, and Troponin (HEART) score is a decision aid designed to risk stratify emergency department (ED) patients with acute chest pain. It has been validated for ED use, but it has yet to be evaluated in a prehospital setting. Hypothesis A prehospital modified HEART score can predict major adverse cardiac events (MACE) among undifferentiated chest pain patients transported to the ED. METHODS:
A retrospective cohort study of patients with chest pain transported by two county-based Emergency Medical Service (EMS) agencies to a tertiary care center was conducted. Adults without ST-elevation myocardial infarction (STEMI) were included. Inter-facility transfers and those without a prehospital 12-lead ECG or an ED troponin measurement were excluded. Modified HEART scores were calculated by study investigators using a standardized data collection tool for each patient. All MACE (death, myocardial infarction [MI], or coronary revascularization) were determined by record review at 30 days. The sensitivity and negative predictive values (NPVs) for MACE at 30 days were calculated.RESULTS:
Over the study period, 794 patients met inclusion criteria. A MACE at 30 days was present in 10.7% (85/794) of patients with 12 deaths (1.5%), 66 MIs (8.3%), and 12 coronary revascularizations without MI (1.5%). The modified HEART score identified 33.2% (264/794) of patients as low risk. Among low-risk patients, 1.9% (5/264) had MACE (two MIs and three revascularizations without MI). The sensitivity and NPV for 30-day MACE was 94.1% (95% CI, 86.8-98.1) and 98.1% (95% CI, 95.6-99.4), respectively.CONCLUSIONS:
Prehospital modified HEART scores have a high NPV for MACE at 30 days. A study in which prehospital providers prospectively apply this decision aid is warranted. Stopyra JP , Harper WS , Higgins TJ , Prokesova JV , Winslow JE , Nelson RD , Alson RL , Davis CA , Russell GB , Miller CD , Mahler SA . Prehospital modified HEART score predictive of 30-day adverse cardiac events. Prehosp Disaster Med. 2018;33(1)58-62.Palabras clave
ACS acute coronary syndrome; AMI acute myocardial infarction; Age; ECG; ECG electrocardiogram; ED emergency department; EMS Emergency Medical Services; HEAR History; HEART History; MACE major adverse cardiac events; MI myocardial infarction; NPV negative predictive value; POC point-of-care; Risk Factors; STEMI ST-elevation myocardial infarction; and Troponin; Emergency Medical Services; acute coronary syndrome; chest pain; decision support techniques
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Dolor en el Pecho
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Troponina T
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Servicios Médicos de Urgencia
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Servicio de Urgencia en Hospital
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Infarto del Miocardio
Tipo de estudio:
Diagnostic_studies
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Etiology_studies
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Incidence_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Límite:
Adult
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Aged
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Female
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Humans
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Male
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Middle aged
País/Región como asunto:
America do norte
Idioma:
En
Revista:
Prehosp Disaster Med
Asunto de la revista:
MEDICINA DE EMERGENCIA
Año:
2018
Tipo del documento:
Article