A retrospective HEART risk score comparation of acute non-traumatic chest pain patients in an emergency department in Spain

Iris Nathalie San Román Arispe,Josep Ramón Marsal Mora,Oriol Yuguero Torres,Marta Ortega Bravo

doi:10.1038/s41598-021-02682-5

Abstract

Non traumatic chest pain is the second most common cause of attention at the Emergency Departments (ED). The objective is to compare the effectiveness of HEART risk score and the risk of having a Major Adverse Cardiovascular Event (MACE) during the following 6 weeks in ‘Acute Non-traumatic Chest Pain’ (ANTCP) patients of an ED in Lleida (Spain). The ANTCP patient cohort was defined using medical data from January 2015 to January 2016. A retrospective study was performed among 300 ANTCP patients. Diagnostic accuracy to predict MACE, HEART risk score effectiveness and patient risk stratification were analysed on the ANTCP Cohort. HEART risk score was conducted on ANTCP Cohort data and patients were stratified as low-risk (n = 116, 38.7%), moderate-risk (n = 164, 54.7%) and high-risk (n = 20, 6.7%); differently from the assessment performed by 'Current Emergency Department Guidelines’ (CEDG) on the same patients: low risk and discharge (n = 56, 18.7%), medium risk and need of complementary tests (n = 137, 45.7%) and high risk and hospital admission (n = 107, 35.7%).The incidence of MACE was 2.5%, 20.7% and 100% in low, moderate and high-risk, respectively. Discrimination and accuracy indexes were moderate (AUC = 0.73, 95% confidence interval: 0.67–0.80). Clustering moderate-high risk groups by MACE incidence showed an 89.5% of sensitivity. Data obtained from this study suggests that HEART risk score stratified better ‘acute non-traumatic chest pain’ (ANTCP) patients in an Emergency Department (ED) compared with ‘Current Emergency Department Guidelines’ (CEDG) at the Hospital Universitari Arnau de Vilanova (HUAV). HEART score would reduce the number of subsequent consultations, unnecessary admissions and complementary tests.Trial registration: Retrospectively registered.

Highlights

The group of ‘Acute Non-Traumatic Chest Pain’ (ANTCP) cases was selected from the database
To more precisely define the Acute Nontraumatic Chest Pain’ (ANTCP) patient cohort, exclusion/inclusion criteria were applied into the ANTCP cases group; and the ANTCP patient cohort was established with a total of 535 patients, from whom 300 patients were selected using a consecutivesystematic sampling
This could be related with the diagnosis routine and it clearly showed that HEART risk score would be a great tool for early classification of the ANTCP patients at Emergency Department (ED) (Fig. 1)

Summary

Methods

Retrospective observational cohort study, including patients who attended the HUAV Emergency. Department with ANTCP, between January 2015 and January 2016. The sources of information were the computerized registry of the clinical file (SAP) of the Hospital Universitary Arnau de Vilanova and the Institut Català de la Salut Primary Care medical registry (e-CAP) of Lleida-Spain. An inclusion of 300 patients in the sample is the minimum to determine a difference in the C statistic for the ROC curves of 0.08, assuming a C statistic for the HEART scale of 0.83 with a type I error of 0.05. A representative sample of 300 patients was obtained from the study population through consecutive sampling, including those patients who met all the inclusion criteria and none of the exclusion criteria

Results

Discussion

Conclusion