Validity of the HEART Score as an Early Assessment Tool for Acute Coronary Syndrome in a Sri Lankan Population: A Single-Centre External Validation Pilot Study

Introduction The HEART score is a clinical tool used for early risk stratification in patients presenting with chest pain in emergency settings, which facilitates prognostication. Although limited, it has been validated in several countries throughout the world. Aims This study aimed to assess the validity of HEART score, in a Sri Lankan population, as an early assessment tool, for risk prediction of acute coronary syndrome (ACS), in patients presenting with chest pain. Methods Data were collected from 74 patients presenting with chest pain to the emergency department (ED) of a tertiary care centre in Sri Lanka. HEART scores were calculated for each patient retrospectively and patients were categorized into low (0-3), intermediate (4-6), and high (7-10) risk groups. The predictive accuracy of the HEART score with a diagnosis of ACS and the occurrence of major adverse cardiac events (MACE) at six weeks was assessed using sensitivity, specificity, predictive values and the area under receiver operating characteristic curve (AUC). Results All patients in the low-risk group (n=8) were correctly identified as non-ACS, with no MACE. All high-risk patients (n=29) had ACS and experienced MACE. Among the intermediate risk group (n=37), 70.3% were diagnosed with ACS and 54% developed MACE at six weeks. AUC for HEART score for a diagnosis of ACS, was 0.889 (95% CI: 0.8171 to 0.9609) while the AUC for occurrence of MACE was 0.9053 (95% CI: 0.8437 to 0.9669). Conclusion Exploratory evidence from this pilot study suggests that the HEART score is an effective early assessment tool which can be used in Sri Lankans, in prediction of the probability of ACS, and MACE within six weeks, in patients presenting with chest pain. However, these findings should be interpreted with caution, given the limited sample size and further confirmation is required in larger multicentre studies.