Khaleghi Rad Mahsan, Pirmoradi Mohammad Mahdi, Doosti-Irani Amin, Thiruganasambandamoorthy Venkatesh, Mirfazaelian Hadi
Department of Emergency Medicine, Tehran University of Medical Sciences, Tehran.
Department of Epidemiology, School of Public Health and Modeling of Non-communicable Diseases Research Center, Hamadan University of Medical Sciences, Hamadan, Iran.
Eur J Emerg Med. 2022 Jun 1;29(3):173-187. doi: 10.1097/MEJ.0000000000000921. Epub 2022 Apr 19.
Chest pain is one of the most common presentations to the emergency department (ED) and HEART score (history, ECG, age, risk factors, and cardiac troponin) is recommended for risk stratification. It has been proposed that the sum of four items with no troponin (HEAR score) below 2 can be used safely to lower testing and reduce length of stay. To assess the performance of the HEAR score in hospital and prehospital settings, we performed a systematic review and meta-analysis. English studies on the performance of the HEAR score in patients with acute chest pain were included. They were excluded if data are inaccessible. MEDLINE, Embase, Evidence-Based Medicine Reviews, Scopus, and web of science were searched from 1946 to July 2021. The quality of studies was assessed using Quality Assessment of Diagnostic Accuracy Studies version 2. Acute coronary syndrome or major adverse cardiac events prediction were outcomes of interest. The performance indices with 95% confidence intervals (CIs) were extracted. Inverse variance and the random-effects model were used to report the results. Of the 692 articles on the HEAR score, 10 studies were included in the analysis with 33 843 patients. Studies were at low to moderate risk of bias. Three studies were in prehospital and three were retrospective. The pooling of data on the HEAR score showed that the sensitivity at the HEAR<2, <3, and <4 cutoffs in the ED were 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. The negative predictive values (NPVs) for the above cutoffs 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. Of note, for the HEAR<2, negative likelihood ratio was 0.07 (95% CI, 0.02-0.12). In the prehospital, at the HEAR<4 cutoff, the pooled sensitivity and NPV were 85.01% (95% CI, 80.56-89.47) and 91.48% (95% CI, 87.10-95.87), respectively. This study showed that in the ED, the HEAR score<2 can be used for an early discharge strategy. Currently, this score cannot be recommended in prehospital setting. Prospero (CRD42021273710).
胸痛是急诊科最常见的症状之一，推荐使用HEART评分（病史、心电图、年龄、危险因素和心肌肌钙蛋白）进行风险分层。有人提出，肌钙蛋白阴性的四项指标之和（HEAR评分）低于2时可安全用于减少检查并缩短住院时间。为评估HEAR评分在医院和院前环境中的表现，我们进行了一项系统评价和荟萃分析。纳入了关于HEAR评分在急性胸痛患者中表现的英文研究。如果数据无法获取则将其排除。检索了1946年至2021年7月期间的MEDLINE、Embase、循证医学综述、Scopus和科学网。使用诊断准确性研究质量评估第2版评估研究质量。急性冠状动脉综合征或主要不良心脏事件预测是感兴趣的结局。提取了具有95%置信区间（CI）的表现指标。采用逆方差和随机效应模型报告结果。在692篇关于HEAR评分的文章中，10项研究纳入分析，共33843例患者。研究存在低至中度偏倚风险。3项研究为院前研究，3项为回顾性研究。HEAR评分数据汇总显示，在急诊科，HEAR<2、<3和<4临界值时的敏感性分别为99.03%（95%CI，98.29-99.77）、97.54%（95%CI，94.50-100）和91.80%（95%CI，84.62-98.98）。上述临界值的阴性预测值（NPV）分别为99.84%（95%CI，99.72-99.95）、99.75%（95%CI，99.65-99.85）和99.57%（95%CI，99.11-100）。值得注意的是，对于HEAR<2，阴性似然比为0.07（95%CI，0.02-0.12）。在院前环境中，在HEAR<4临界值时，汇总的敏感性和NPV分别为85.01%（95%CI，80.56-89.47）和91.48%（95%CI，87.10-95.87）。本研究表明，在急诊科，HEAR评分<2可用于早期出院策略。目前，该评分在院前环境中不推荐使用。国际前瞻性系统评价注册库（CRD42021273710）。
