Decision Aids for Low-Risk Chest Pain.

The combination of TIMI score and HEART score identifies patients at less than 1% risk for death or cardiac events within 30 days.


Patients with “low-risk” chest pain consume enormous resources with extremely low yield from observation and testing such as exercise tolerance testing. Decision aids could be useful in such cases; however, neither the Thrombolysis in Myocardial Infarction (TIMI) score nor the HEART score is sufficiently sensitive to predict 30-day cardiac events (missing 2% to 3% of such events). Both scores consider symptoms, age, risk factors, and electrocardiogram findings, and the HEART score also incorporates troponin testing.

To determine whether combining the scores would further risk stratify patients, researchers retrospectively calculated the HEART score for a cohort of 9000 patients who had TIMI scores calculated as part of their evaluation for possible ischemia in a prior study. No patient with a TIMI score of 2 and a HEART score of zero had any of the events in the composite endpoint of death, acute MI, or coronary artery revascularization within 30 days.

Comment: The HEART score takes more time to calculate and is more subjective than the TIMI score, and using the two scores together during clinical care would be difficult without computerized decision support. Nevertheless, risk assessment of these patients is critical if resources are to be directed appropriately toward higher-yield testing.



Journal Watch Emergency Medicine


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