The feasibility of HEAR score in comparison to Modified HEART score as a risk stratification tool for chest pain patients presented to Emergency Department Hospital Universiti Sains Malaysia

INTRODUCTION: Risk stratification tools that integrate clinical, ECG findings and cardiac biomarkers have been used to facilitate the management of chest pain patients in the emergency department (ED). We studied the feasibility of history, age, electrocardiogram and risk factors (HEAR) score as a risk stratification tool for chest pain patients presented to ED Hospital Universiti Sains Malaysia (HUSM) in comparison to modified HEART score (MHS) based on major adverse cardiac events (MACE) within 6 weeks' time.

MATERIALS AND METHODS: We analysed retrospective data of chest pain patients presenting to ED HUSM from 1st June 2020 till 31st January 2021 based on the patient's history, ECG findings, risk factors, age and troponin level. The patients were stratified as low risk (MHS and HEAR score of 0-3), intermediate risk (MHS and HEAR score of 4-6), and high risk (MHS of 7-10 and HEAR score of 7-8). The association of the MHS and HEAR score with MACE at 6 weeks' time was evaluated using simple logistic regression.

RESULTS: This study included 147 patients in the MHS analysis and 71 patients in HEAR score analysis. The incident rate of MACE in low, intermediate and high risk was 0%,16.3%, and 34.7%, in the MHS group, and 0%, 3.22%, and 6.66% in HEAR score group. The mean difference between MACE and non-MACE in MHS and HEAR score groups was -2.29 (CI: -3.13,1.44, p<0.001) and -2.51(CI: -5.23, 0.21, p=0.070), respectively. There was no significant association between the incidence rate of MACE with modified HEART score (MHS) and HEAR score groups (p>0.95).

CONCLUSION: HEAR score is not feasible to be used as a risk stratification tool for chest pain patients presenting to ED HUSM in comparison to MHS. Further studies are required to validate the results.