Department of Cardiology, Isala Hospital, The Netherlands.
Department of Cardiology, Deventer Hospital, The Netherlands.
Eur J Cardiovasc Nurs. 2021 Feb 11;20(1):40-47. doi: 10.1177/1474515120927867.
Although increasing evidence shows that in patients with suspected non-ST-elevation acute coronary syndrome (NSTE-ACS) both hospital and pre-hospital acquired HEART (History, ECG, Age, Risk factors, Troponin) scores have strong predictive value, pre-hospital and hospital acquired HEART scores have never been compared directly.
In patients with suspected NSTE-ACS, the HEART score was independently prospectively assessed in the pre-hospital setting by ambulance paramedics and in the hospital by physicians. The hospital HEART score was considered the gold standard. Low-risk (HEART score ≤3) was considered a negative test. Endpoint was occurrence of major adverse events within 45 days.
A total of 699 patients were included in the analyses. In 516 (74%) patients pre-hospital and hospital risk classification was similar, in 50 (7%) pre-hospital risk classification was false negative (45 days mortality 0%) and in 133 (19%) false positive (45 days mortality 1.5%). False negative risk classifications were caused by differences in history (100%), risk factor assessment (66%) and troponin (18%) and were more common in older patients. Occurrence of major adverse events was comparable in pre-hospital and hospital low-risk patients (2.9% vs. 2.7%, p = 0.9). Incidence of major adverse events was 0% in the true negative group, 26% in the true positive group, 10% in the false negative group and 5% in the false positive group. Predictive value of both pre-hospital and hospital acquired HEART scores was high, although the 'area under the curve' of hospital acquired HEART score was higher (0.84 vs. 0.74, p < 0.001).
In approximately 25% of patients hospital and pre-hospital HEART score risk classifications disagree, mainly by risk overestimation in the pre-hospital group. Since disagreement is primarily caused by different scoring of history and risk factors, additional training may improve pre-hospital scoring.
尽管越来越多的证据表明，在疑似非 ST 段抬高型急性冠状动脉综合征（NSTE-ACS）患者中，医院和院前获得的 HEART（病史、心电图、年龄、危险因素、肌钙蛋白）评分均具有较强的预测价值，但院前和医院获得的 HEART 评分从未直接进行过比较。
在疑似 NSTE-ACS 的患者中，由救护车护理人员在院前环境中，以及由医生在医院中，独立地对 HEART 评分进行前瞻性评估。医院 HEART 评分被认为是金标准。低危（HEART 评分≤3）被视为阴性试验。终点为 45 天内发生主要不良事件。
共纳入 699 例患者进行分析。在 516 例（74%）患者中，院前和医院的风险分类相似，在 50 例（7%）患者中，院前风险分类为假阴性（45 天死亡率为 0%），在 133 例（19%）患者中为假阳性（45 天死亡率为 1.5%）。假阴性风险分类是由病史（100%）、危险因素评估（66%）和肌钙蛋白（18%）的差异引起的，并且在老年患者中更为常见。在院前和医院低危患者中，主要不良事件的发生情况相当（2.9% vs. 2.7%，p=0.9）。在真阴性组中，主要不良事件的发生率为 0%，在真阳性组中为 26%，在假阴性组中为 10%，在假阳性组中为 5%。尽管医院获得的 HEART 评分的“曲线下面积”更高（0.84 比 0.74，p<0.001），但院前和医院获得的 HEART 评分的预测价值均较高。
在大约 25%的患者中，医院和院前 HEART 评分的风险分类存在差异，主要是由于院前组的风险高估。由于差异主要是由病史和危险因素评分的不同引起的，因此额外的培训可能会提高院前评分的准确性。
