A study of HEART score in patients presenting with chest pain to the emergency medicine department in Pudukkottai, Southern Tamil Nadu

ABSTRACT Background: The diagnosis of acute coronary syndrome (ACS) is fundamental for the early detection and distinction of chest pain from alternative causes, as it is a common and life-threatening reason for Emergency Medicine Department (EMD) admission. The history, electrocardiogram, age, risk factors, and initial troponin (HEART) score which was recently diagnosed is intended for early risk stratification of patients presenting with chest pain in EMD, and categories them into low, intermediate, or high-risk of experiencing major adverse cardiac events (MACEs) within 6-weeks, serves as an indicator of ACS. To evaluate the effectiveness of HEART scores in patients presenting with chest pain in the EMD and to stratify them using HEART score. Methodology: This 6-month prospective study was done in 239 patients presented in EMD with chest pain in Government Medical College Hospital, South India. After obtaining Institutional Review Board approval and informed consent, patients were categorized based on HEART score. The patients were followed for 6 weeks through telephone to identify MACEs after discharge. Analysis was done using the SPSS (Ver. 24) software. Results: Among 239 patients, 52.7%, 35.1%, and 12.1% of patients were stratified as low, moderate, and high risk, respectively, using HEART score. Of which low-risk and high-risk category, 1.6% and 89.7% developed MACE at 6 weeks, where 46 patients had acute myocardial infarction, 42 patients underwent invasive procedure, and five patients died. Moderate HEART score risk patients had 34.5% of MACE which suggests admission and further evaluation to prevent cardiac complication. Conclusion: Our study suggests that if HEART score is adopted for risk stratifying patients who are presenting with chest pain to ED half of the patients can be very well discharged from ED based on the clinical evaluation and prevent the further complications in high-risk patients.