How effective is HEAR score for risk stratification of ED patients?

Use of the History, Electrocardiogram, Age, Risk factors (HEAR) scores is limited in patients with baseline high-sensitivity cardiac troponin T (hs-cTnT) <LoQ (limit of quantitation) or hs-cTnT >99th percentile to define short-term prognosis, according to a study.

“In those with baseline quantifiable hs-cTnT within the reference range (<99th percentile), a higher risk (>1 percent) for 30-day major adverse cardiovascular event (MACE) exists even in those with low HEAR scores,” the authors said. “With serial hs-cTnT measurements, HEAR scores overestimate risk when hs-cTnT remains <99th percentile.”

A total of 1,979 emergency department (ED) patients without ST-elevation myocardial infarction who had at least one hs-cTnT (LoQ <6 ng/L, and sex-specific 99th percentiles of 10 ng/L for women and 15 ng/L for men) measurement on clinical indications, in whom HEAR scores (0-8) were calculated, were included in this retrospective, multicentre, observational study.

Of the participants, 1,045 (53 percent) were low risk (0‒3), 914 (46 percent) intermediate risk (4‒6), and 20 (1 percent) high risk (7‒8) based on HEAR scores. Adjusted analyses revealed no association between HEAR scores and increased risk of 30-day MACE.

Irrespective of HEAR scores, patients with quantifiable hs-cTnT (LoQ-99th) were at greater risk for 30-day MACE (3.4 percent), while those with serial hs-cTnT <99th percentile remained at low risk (range, 0‒1.2 percent) across all HEAR score strata. Notably, higher scores showed no association with long-term (2 years) events.

“The 2021 American College of Cardiology/American Heart Association chest pain guidelines recommend risk scores such as HEAR for short-term risk stratification, yet limited data exist integrating them with hs-cTnT,” the authors said.