One of the most frequent reasons for visiting the emergency department (ED) is chest discomfort, and the HEART score (history, ECG, age, risk factors, and cardiac troponin) is advised for risk stratification. It has been suggested that the HEAR score, which is the average of 4 categories with no troponin below 2, can be used to decrease testing and shorten hospital stays without risk.
Researchers conducted a systematic review and meta-analysis to evaluate how well the HEAR score worked in hospital and prehospital settings. The HEAR score’s performance in patients with acute chest discomfort was covered in English research. If the data were unavailable, they were excluded. From 1946 to July 2021, MEDLINE, Embase, Evidence-Based Medicine Reviews, Scopus, and Web of Science were searched. Utilizing Quality Assessment of Diagnostic Accuracy Studies version 2, the studies’ caliber was evaluated.
The outcomes of interest included the prediction of significant adverse cardiac events or acute coronary syndrome. The 95% CIs for the performance metrics were extracted. Results were reported using the random-effects model and inverse variance. Ten studies comprising 33,843 people were included in the analysis of the 692 papers on the HEAR score. There was a low to moderate risk of bias in the studies. Three prehospital studies and three retrospective studies were conducted. In the ED, the sensitivity at the HEAR less than 2, less than 3, and less than 4 cutoffs was 99.03% (95% CI, 98.29-99.77), 97.54% (95% CI, 94.50-100), and 91.80% (95% CI, 84.62-98.98), respectively, according to the pooling of the HEAR score data. For each of the aforementioned cutoffs, the negative predictive values (NPVs) were 99.84% (95% CI, 99.72-99.95), 99.75% (95% CI, 99.65-99.85), and 99.57% (95% CI, 99.11-100), respectively. Notably, the negative likelihood ratio for the HEAR less than 2 was 0.07 (95% CI: 0.02-0.12). The pooled sensitivity and NPV in the prehospital setting at the HEAR less than 4 threshold were 85.01% (95% CI, 80.56-89.47) and 91.48% (95% CI, 87.10-95.87), respectively.
The study demonstrated that an early discharge strategy in the ED might utilize the HEAR score 2. The score is currently not acceptable in prehospital settings.