Department of Emergency Medicine, John Peter Smith Health Network, 1500 S. Main St., Fort Worth, TX, 76104, USA.
Department of Cardiology, JPS Health Network, 1500 S. Main St., Fort Worth, TX, 76104, USA.
High Blood Press Cardiovasc Prev. 2021 Jan;28(1):69-78. doi: 10.1007/s40292-020-00426-6. Epub 2020 Dec 28.
The HEART score is used to effectively risk stratify undifferentiated chest pain patients in the Emergency Department (ED). It is unclear whether such risk stratification can be applied among ED high utilizers. We aim to determine the efficacy and safety of using the HEART score to predict 30-day short-term major adverse cardiac events (MACE) in ED high utilizers. We conducted a retrospective, observational study in which ED high utilizers were defined as patients who had four or more ED visits within the past 12 months. ED high utilizers presenting at the study ED with chest pain were enrolled. Patients in which the HEART score was utilized were placed in the HEART group and patients with no HEART scores documented were placed to the usual care group. Hospital admissions and cardiac stress tests performed during the index hospitalizations, and 30-day MACE rates were analyzed and compared between the HEART and usual care groups. From January 1, 2017 to December 31, 2019, a total of 8,315 patient visits from ED high utilizers were enrolled. In the HEART group, 49% of ED visits were admitted with 20% receiving stress tests. A 30-day MACE outcome occurred among 1.4% of visits. In the usual care group, 44% of ED visits were admitted, with only 9% receiving index stress tests and a 1.5% of 30-day MACE occurrence (p=0.727). The study showed that similar short-term MACE outcomes occurred between patients using HEART scores and usual care to risk stratify chest pain among ED high utilizers.
HEART 评分用于有效对急诊科（ED）中未明确诊断的胸痛患者进行危险分层。尚不清楚这种危险分层是否可应用于 ED 高使用率人群。我们旨在确定使用 HEART 评分预测 ED 高使用率人群 30 天短期主要不良心脏事件（MACE）的疗效和安全性。我们进行了一项回顾性观察性研究，其中 ED 高使用率定义为过去 12 个月内有 4 次或更多 ED 就诊的患者。在研究 ED 因胸痛就诊的 ED 高使用率患者被纳入研究。在就诊时使用 HEART 评分的患者被归入 HEART 组，而没有记录 HEART 评分的患者被归入常规护理组。分析和比较了两组之间在指数住院期间的住院和心脏应激试验情况，以及 30 天 MACE 发生率。2017 年 1 月 1 日至 2019 年 12 月 31 日，共纳入 8315 例 ED 高使用率患者就诊。在 HEART 组中，49%的 ED 就诊需要住院治疗，其中 20%接受了应激试验。1.4%的就诊发生 30 天 MACE 结局。在常规护理组中，44%的 ED 就诊需要住院治疗，只有 9%接受了指数应激试验，30 天 MACE 发生率为 1.5%（p=0.727）。该研究表明，在 ED 高使用率人群中，使用 HEART 评分和常规护理进行危险分层的胸痛患者短期 MACE 结局相似。
