Internal and Emergency Medicine

, Volume 13, Issue 5, pp 727–748 | Cite as

A retrospective external validation study of the HEART score among patients presenting to the emergency department with chest pain

  • Matthew Jay StreitzEmail author
  • Joshua James Oliver
  • Jessica Marie Hyams
  • Richard Michael Wood
  • Yevgeniy Mikhaylovich Maksimenko
  • Brit Long
  • Robert Michael Barnwell
  • Michael David April


Emergency physicians must be able to effectively prognosticate outcomes for patients presenting to the Emergency Department (ED) with chest pain. The HEART score offers a prognostication tool, but external validation studies are limited. We conducted an external retrospective validation study of the HEART score among ED patients presenting to our ED with chest pain from 1 January 2014 to 9 June 2014. We utilized chart review methodology to abstract data from each patient’s electronic medical record. We collected data relevant to each of the five elements of the HEART score: history, electrocardiogram (ECG) interpretation, patient age, patient risk factors, and troponin levels. We calculated the diagnostic accuracy of the HEART score (0–10) for predicting the primary outcome of major adverse cardiac events (MACE) over 6 weeks following the ED visit (coronary revascularization, myocardial infarction, or mortality). We randomly selected 10% of patient charts from which a second investigator abstracted all data to assess inter-rater reliability for all study variables. Of 625 charts reviewed, we abstracted data on 417 (66.7%) consecutive patients meeting study inclusion criteria. Thirty-one (7.4%) of these patients experienced 6-week MACE. We observed no instances of MACE within 6 weeks among subjects with a HEART score of 3 or less. The area under the receiver operator curve (AUROC) is 0.885 (95% confidence interval 0.838–0.931). Patients with a HEART score ≤3 are at low risk for 6-week MACE. Hence, these patients may be candidates for outpatient follow-up instead of inpatient admission for cardiac risk stratification.


Chest pain HEART score Low risk Emergency department Acute coronary syndrome 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.



Statement of human and animal rights

For this type of study formal consent was not required. This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was waived at our institution due to the chart review nature of the study.


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Copyright information

© SIMI (outside the USA) 2017

Authors and Affiliations

  1. 1.Department of Emergency MedicineSan Antonio Military Medical Center, San Antonio Uniformed Services Health Education ConsortiumSan AntonioUSA
  2. 2.Uniformed Services University of the Health Sciences4301, Jones Bridge RdBethesdaUSA

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