Methodology: 3.5/5
Usefulness: 2.5/5

O’Rielly CM, et al. CJEM. 2021 Jul 17. doi: 10.1007/s43678-021-00159-y.

Question and Methods:  Secondary analysis validation study that sought to validate proposed HEAR score’ ability to identify low risk patients for acute myocardial infarction (AMI) and 30 days major cardiac events (MACE) who are unlikely to benefit from troponin testing.
Findings:  HEAR scores ≤ 1 had sensitivities above 98% and negative predictive value above 99% for index AMI and 30 days MACE respectively. 
Limitations:  Small population studied. Single centre retrospective cohort with all patients initially requiring troponin testing to rule out AMI.

Interpretation:  This validation study shows potential to identify select patients at very low risk of AMI / MACE with HEAR ≤ 1 who would likely not benefit from troponin testing in ED. Further validation studies with larger populations are needed before this strategy is adopted in clinical settings.  

By: Dr. Alexandre Pelletier