Heart Score //FREE\\

This graph shows that the HEART score is a perfect predictor of MACE within six weeks after presentation at the emergency room. The X axis represents the increasing HEART score of a patient, while the Y axis indicates the increasing risk of a cardiac event. The S shaped curve represents a discrimination between low risk and high risk patients. Low HEART scores accompany a low likelihood of MACE; high HEART scores predict high incidence of MACE.

Background: The focus of the diagnostic process in chest pain patients at the emergency department is to identify both low and high risk patients for an acute coronary syndrome (ACS). The HEART score was designed to facilitate this process. This study is a prospective validation of the HEART score.

Heart Score

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Methods: A total of 2440 unselected patients presented with chest pain at the cardiac emergency department of ten participating hospitals in The Netherlands. The HEART score was assessed as soon as the first lab results and ECG were obtained. Primary endpoint was the occurrence of major adverse cardiac events (MACE) within 6 weeks. Secondary endpoints were (i) the occurrence of AMI and death, (ii) ACS and (iii) the performance of a coronary angiogram. The performance of the HEART score was compared with the TIMI and GRACE scores.

Results: Low HEART scores (values 0-3) were calculated in 36.4% of the patients. MACE occurred in 1.7%. In patients with HEART scores 4-6, MACE was diagnosed in 16.6%. In patients with high HEART scores (values 7-10), MACE occurred in 50.1%. The c-statistic of the HEART score (0.83) is significantly higher than the c-statistic of TIMI (0.75)and GRACE (0.70) respectively (p

Conclusion: The HEART score provides the clinician with a quick and reliable predictor of outcome, without computer-required calculating. Low HEART scores (0-3), exclude short-term MACE with >98% certainty. In these patients one might consider reserved policies. In patients with high HEART scores (7-10) the high risk of MACE may indicate more aggressive policies.

To The Editor: In this article, Barstow and colleagues discuss two risk scores to evaluate the likelihood of coronary artery disease as a cause of chest pain. However, the authors did not discuss the HEART (history, electrocardiography, age, risk factors, troponin) score, an easy-to-use, well-validated risk score that I use daily as a hospitalist in a chest pain observation unit.

Compared with the TIMI (thrombolysis in myocardial infarction) score, the HEART score (see accompanying table) has a better predictive capacity for acute coronary syndrome (C statistic of 0.83 vs. 0.75 for TIMI).1 When used as part of an accelerated diagnostic protocol with serial troponin measurements, the HEART score can safely identify more patients for early discharge, reduce rates of objective cardiac testing, and significantly lower length of stay compared with usual care.2

As part of an accelerated diagnostic protocol, a low-risk HEART score paired with repeat troponin measurements at three to six hours after presentation can further identify patients with minimal risk of complications. Two studies with a total of 1,287 patients found only one incidence of MACE in low-risk patients that was not identified by this protocol.3,4 These patients are good candidates for rapid discharge, and I usually refer them back to their primary care physician or cardiologist without pursuing other urgent ischemic evaluation.

The HEART score is easy to use at the bedside, provides reassurance that the patient is low risk and that early discharge is safe, and can help reduce costs associated with the evaluation of chest pain.

Mahler SA, Heistad BC, Goff DC, et al. Can the HEART score safely reduce stress testing and cardiac imaging in patients at low risk for major adverse cardiac events?. Crit Pathw Cardiol. 2011;10(3):128-133.

One study has shown that patients with a modified TIMI score of 0 and two negative ECGs with two negative troponin results separated by two hours can be safely discharged from the emergency department and scheduled for a stress test within 72 hours. The 30-day risk of MACE was less than 1% in these patients.1

Unlike the TIMI and GRACE (Global Registry of Acute Coronary Events) scores, which were originally developed as prognostic tools for patients with an acute coronary syndrome diagnosis, the HEART score was prospectively developed and validated specifically to identify patients at low risk of acute coronary syndrome in the emergency department.2 Dr. Gomez did an excellent job of citing the data in support of the HEART score. In summary, a low-risk HEART score coupled with two negative cardiac troponin tests drawn three to six hours apart has a negative predictive value of 30-day MACE that approaches 100%.3

Although a recent study showed noninvasive testing for patients with negative troponin testing and a nonischemic ECG did not result in improved clinical outcomes,4 this was a retrospective analysis of a trial designed to evaluate the use of coronary computed tomography angiography in the early evaluation of chest pain. This trial probably should not be applied to general practice. For patients with an intermediate-risk HEART score, it is prudent to admit for additional testing, and patients with a high-risk HEART score should be evaluated for possible invasive testing.

Mahler SA, Hiestand BC, Goff DC, Hoekstra JW, Miller CD. Can the HEART score safely reduce stress testing and cardiac imaging in patients at low risk for adverse cardiac events?. Circ Pathw Cardiol. 2011;10(3):128-133.

Use of inhaled nicotine delivery products, which includes traditional cigarettes, e-cigarettes and vaping, is the leading cause of preventable death in the U.S., including about a third of all deaths from heart disease. And about a third of U.S. children ages 3-11 are exposed to secondhand smoke or vaping.Learn how to stop smoking.

Most of the food we eat is turned into glucose (or blood sugar) that our bodies use as energy. Over time, high levels of blood sugar can damage your heart, kidneys, eyes and nerves. As part of testing, monitoring hemoglobin A1c can better reflect long-term control in people with diabetes or prediabetes.Learn how to control blood sugar.

A coronary calcium scan uses computerized tomography (CT) imaging to take pictures of your heart's arteries. It can detect calcium deposits in the coronary arteries. Calcium deposits can narrow the arteries and increase the risk of a heart attack. The image on the left shows where the heart is typically located in the body (A). The middle image shows the area of the coronary calcium scan image (B). The image on the right shows a coronary calcium scan (C).

A coronary calcium scan is a special computerized tomography (CT) scan of the heart. It looks for calcium deposits in the heart arteries. A buildup of calcium can narrow the arteries and reduce blood flow to the heart. A coronary calcium scan may show coronary artery disease before you have symptoms.

Coronary artery disease is a common heart condition. A buildup of calcium, fats and other substances in the heart arteries are often the cause. This buildup is called plaque. Plaque collects slowly over time, long before there are any symptoms of coronary artery disease.

Some medical centers advertise coronary calcium scans as an easy way to measure the risk of a heart attack. These scans often don't require a referral. But they might not be covered by insurance. Less expensive blood tests and blood pressure checks can help your health care team learn more about your heart attack risk. Ask your doctor what heart tests are best for you.

The test score also may be given as a percentage. The number is the amount of calcium in the arteries compared to other people of the same age and sex. Calcium scores of about 75% have been linked with a significantly higher risk for heart attacks.

Your health care team gives you your coronary calcium scan results. The result of a coronary calcium scan shouldn't be used as a single sign of your overall health and risk of heart disease. The information from the scan should be reviewed with other health information.

The Healthy Heart Score was created by a team from the Department of Nutrition at Harvard School of Public Health to fill this gap. It estimates cardiovascular disease risk in seemingly healthy individuals. The Healthy Heart Score is a simple tool that can be used to identify individuals at high risk for cardiovascular disease due to unhealthy lifestyle habits. Its use is intended to complement, not replace, existing primary prevention risk scores, since different calculators may be most appropriate for different populations.

Current primary prevention models like the Framingham risk score often underestimate the risk of cardiovascular disease in these patients. In addition, the Healthy Heart Score does not depend on the results of blood tests or other clinical information, and so can also be used by individuals interested in better understanding their cardiovascular health based on information they have at hand. It may also help heighten awareness for lifestyle changes such as exercising more or adopting a more healthful diet that can prevent the development of risk factors for cardiovascular disease, rather than treating them once they become worrisome.

Thoracic radiography often provides the first glimpse of cardiac structures in dogs being evaluated for potential heart disease. Though an important diagnostic tool, the mostly subjective nature of radiographic review poses a challenge when evaluating the heart. Subjective impressions of heart size can be influenced by the relationship between the cardiac silhouette and the surrounding lung fields, with smaller lung fields contributing to an impression of a larger cardiac silhouette. Expiration and chest conformations that obscure lung field visibility may thereby lead to false assessment of an enlarged cardiac silhouette. 17dc91bb1f