Abstract 226: Predicting Major Adverse Cardiac Events Using HEART Score in the Elderly

Abstract

Background: The HEART score was developed to predict major adverse cardiac events (MACE) within 6 weeks in patients evaluated for chest pain. In the established score, age is scored as <45 years old (y/o) = 0 points, 45-64 y/o = 1 point, and >65 y/o = 2 points. The average age of patients in the original study by Backus et al was 61.2 y/o. Our aim is to evaluate the prognostic value of the HEART score in patients >65 y/o. We hypothesized that elderly patients are at increased risk of MACE unaccounted for by the established age scoring system. Methods: We retrospectively reviewed 668 emergency room visits for chest pain (excluding STEMI) between 2016 to 2018 at a single tertiary, urban medical center. HEART scores were calculated based on presenting data. The primary outcome was MACE (MI, PCI, CABG, or death) within 6 weeks. Patients >65 y/o were stratified to 65-74 y/o, 75-84 y/o, and >85 y/o. Primary outcomes were compared between these age groups. Differences in HEART scores between age groups were controlled by comparing patients within the same HEART score brackets (4-6, 7-8, 9-10). Chi squared analysis was used to determine statistically significant differences in MACE (p<0.01). Results: The average age was 60.2 y/o and average HEART score 5.56. There was statistically significant increase in MACE between <45 y/o (18.5%), 45-64 y/o (36.6%), and >65 y/o (47.4%), as outlined by the established HEART score (p<0.01). However, when comparing 65-74 y/o (45.7%), 75-84 y/o (48.8%) and >85 y/o (48.8%), increasing age did not correlate with increasing rate of MACE (p=0.90). When controlled for differences in HEART scores, there was again no statistically significant increase rates of MACE between 65-74 y/o, 75-84y/o, and >85 y/o across all HEART score brackets (4-6, 7-8, 9-10). Conclusion: In patients >65 y/o, increasing age did not correlate with increasing rate of MACE refuting our hypothesis. This represents that the other components of the HEART score have greater impact on prognosis than age in this elderly patient population. Our findings support the current age stratification of the established HEART score and show that even in the very elderly, the HEART score adequately accounts for age as a contributor to MACE.