Abstract
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 of a tertiary care centre in Sri Lanka. HEART scores were retrospectively calculated from prospectively collected clinical and laboratory data. The scores were not used in real-time clinical decision-making. The 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: In this pilot cohort, none of the patients classified as low risk (n=8) were diagnosed with ACS or developed 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 demonstrated promising discriminatory performance for identifying ACS and short-term MACE in this Sri Lankan cohort. However, these findings should be interpreted with caution, given the limited sample size and further confirmation is required in larger multicentre studies.