| Title |
An external validation of the HEART pathway among Emergency Department patients with chest pain
|
|---|---|
| Published in |
Internal and Emergency Medicine, March 2018
|
| DOI | 10.1007/s11739-018-1809-y |
| Pubmed ID | |
| Authors |
Joshua James Oliver, Matthew Jay Streitz, Jessica Marie Hyams, Richard Michael Wood, Yevgeniy Mikhaylovich Maksimenko, Brit Long, Robert Michael Barnwell, Michael David April |
| Abstract |
The impact of an outpatient disposition strategy for patients with HEART score 0-3 (HEART pathway) on HEART score prognostic accuracy is unclear. Our objective is to perform an external validation the HEART score in the setting of recent implementation of the HEART pathway. We conducted an external validation study of the HEART pathway among patients presenting to our ED with chest pain 6 weeks after institutional implementation of a HEART pathway outpatient disposition pathway. We reviewed the charts of 625 consecutive patients with chest pain. Data abstracted included all elements of the HEART score to include history, electrocardiogram (ECG) read, patient age, patient risk factors, and troponin levels. We also reviewed each patient's record for evidence of major adverse cardiac events (MACE) to include mortality, myocardial infarction, or coronary revascularization over 6 weeks following their initial ED visit. We double-abstracted 10% of the charts for quality assurance purposes. Of 625 charts, 449 patients met all criteria for study inclusion. Of these, 25 subjects (5.56%) experience 6-week MACE. No subject with a score of 3 or less has a MACE at 6 weeks (100% sensitivity, 38.7% specificity). The area under the receiver operator curve (AUROC) is 0.898 (95% confidence interval 0.847-0.950). Kappa coefficients for inter-rater reliability range from 0.62 for the history component of the HEART score to 1.0 for troponin. A low HEART score (0-3) maintains excellent sensitivity for predicting 6-week MACE in the setting of an outpatient disposition pathway for these patients. |
X Demographics
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Geographical breakdown
| Country | Count | As % |
|---|---|---|
| United Kingdom | 1 | 100% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Members of the public | 1 | 100% |
Mendeley readers
The data shown below were compiled from readership statistics for 34 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Unknown | 34 | 100% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Researcher | 7 | 21% |
| Other | 3 | 9% |
| Student > Bachelor | 3 | 9% |
| Student > Master | 3 | 9% |
| Student > Doctoral Student | 2 | 6% |
| Other | 8 | 24% |
| Unknown | 8 | 24% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 19 | 56% |
| Unspecified | 2 | 6% |
| Nursing and Health Professions | 1 | 3% |
| Decision Sciences | 1 | 3% |
| Engineering | 1 | 3% |
| Other | 0 | 0% |
| Unknown | 10 | 29% |
Attention Score in Context
This research output has an Altmetric Attention Score of 1. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 08 March 2018.
All research outputs
#18,590,133
of 23,026,672 outputs
Outputs from Internal and Emergency Medicine
#708
of 954 outputs
Outputs of similar age
#258,064
of 331,974 outputs
Outputs of similar age from Internal and Emergency Medicine
#11
of 15 outputs
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