Not all HEART scores are created equal: identifying 'low‐risk' patients at higher risk

Autor: Rita F. Redberg, Ernest Shen, Visanee V. Musigdilok, Chengyi Zheng, Yi-Lin Wu, Benjamin C. Sun, Stacy Park, Kimon L.H. Ioannides, Adam L. Sharp, Ming-Sum Lee, Maros Ferencik, Aileen Baecker
Jazyk: angličtina
Rok vydání: 2020
Předmět:
Zdroj: Journal of the American College of Emergency Physicians Open
ISSN: 2688-1152
Popis: Objective We sought to identify sub‐groups of “low‐risk” HEART score patients (history, ECG, age, risk factors, and troponin) at elevated risk of acute myocardial infarction or death within 30 days. Methods We performed a secondary analysis of prospective emergency department (ED) encounters for suspected acute coronary syndrome in a large health system with low‐risk HEART scores (0–5 points). Logistic regression using the 5 components of the HEART score analyzed the increase risk attributable to points from each of the 5 score components. Results Of 30,971 encounters among 28,992 unique patients, 135 (0.44%, 95% confidence interval [CI] = 0.37–0.51) experienced acute myocardial infarction or death. Risk increased for each component of the HEART score from 0 to 1 to 2 points (history, 0.4% to 0.5% to 0.6%; ECG, 0.3% to 0.7% to 0.7%; age, 0.2% to 0.3% to 0.7%; risk factors, 0.1% to 0.4% to 0.8%), except troponin, which had the highest risk with 1 point (troponin, 0.4% to 2.7% to 0.9%). Odds ratios from our regression, which adjusts for other components, showed a similar pattern (from 1 vs 0 and 2 vs 0 points, respectively: history, 1.0 and 1.8; ECG, 2.2 and 3.5; age, 1.2 and 2.1; risk factors, 2.4 and 4.2; and troponin, 6.0 and 3.6). Conclusion Among “low‐risk” suspected acute coronary syndrome encounters, increasing points within each of the 5 categories demonstrated small increases in risk of death or acute myocardial infarction, with the troponin and ECG components representing the largest risk increases.
Databáze: OpenAIRE
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