Methodology: 3/5
Usefulness: 2/5

Soares WE 3rd, et al. Ann Emerg Med. 2021 Aug;78(2):231-241.

Questions and Methods: This study compared agreement in HEART scores derived by ED physicians and those derived by researchers using a prospective cohort study of adults with cardiac chest pain. 
Findings: In a sample of 336 patients, HEART score agreement between ED clinicians and researchers was moderate: 78% (Cohen’s Kappa 0.48, 95% confidence interval 0.37 to 0.58).
Limitations: Research-derived HEART scores performed poorly at predicting 30-day MACE, verification bias limited the discovery of MACE in low-risk HEART score patients, and the study was powered for an outcome other than the primary outcome.

Interpretation: HEART scores completed by ED physicians are highly sensitive at ruling out 30-day MACE in patients with chest pain, despite only moderate agreement between clinicians and researchers. HEART scores may be most relevant to the management of patients with a moderate pre-test probability of CAD.

By: Dr. Graham Mazereeuw

Supervision: Dr. Jeff Perry