HEART Score Research Articles

Management of acute chest pain in the Emergency Department: benefits of coronary computed tomography angiography.

Acute chest pain (ACP) is a frequent cause of Emergency Department (ED) admissions, with millions of cases reported globally each year. Timely and accurate diagnosis is crucial due to the wide range of underlying causes, such as acute coronary syndrome (ACS), pulmonary embolism (PE), aortic dissection, and others. Misdiagnosis can lead to missed life-saving interventions or, alternatively, unnecessary hospitalizations, escalating healthcare costs. While risk stratification tools like the HEART, GRACE, and TIMI scores are useful, additional imaging is often required to achieve diagnostic precision. Coronary computed tomography angiography (CCTA) has shown significant potential in enhancing diagnostic accuracy and improving patient outcomes. In this review, we explore the challenges physicians encounter when evaluating ACP in the ED, emphasizing the utility of CCTA as a key diagnostic tool. Additionally, we present a clinical case that illustrates how CT scan effectively aids in diagnosing patients with ambiguous symptoms, with CT imaging playing a pivotal role in identifying the underlying pathology.

Abstract 4122284: HEART Score Classification of Major Adverse Cardiovascular Events in Patients with Diabetes Mellitus

Introduction: Risk stratifying diabetes mellitus (DM) patients with chest pain in the emergency department (ED) can pose significant challenges because of atypical symptoms, non-specific ECG changes, and elevated baseline troponin levels. This study aims to evaluate HEART Score performance in DM versus non-DM patients. Methods: A prospective observational cohort study included chest pain patients transported by Emergency Medical Services to University of Pittsburgh Medical Center-affiliated hospitals. Data collection involved extracting data from electronic health records, including both DM and non-DM patients with chest pain. The HEART Score was retrospectively calculated by impartial assessors.The primary endpoint was major adverse cardiac events (MACE) within 30 days. This analysis included the classification performance of bivariate comparisons between the HEART Score and ACS outcomes using the area under the receiver-operator characteristic curve (AUC). Results: 4,058 patients were included. 52.7% were male, 42% were white, there was a mean age of 59.24 years (16.13 SD), 28.63% had DM, and 22.1% had MACE. MACE prevalence was 19.7% in non-DM patients and 28% in patients with DM. The AUC demonstrated more robust discriminatory ability of the HEART Score in non-DM (AUC = 0.81) (95% CI 0.79-0.83) versus DM patients (AUC = 0.74) (95% CI 0.71-0.78) (p 0.001). The performance of HEART Score components, including history, age, and risk factors, exhibited better significant predictive capability for MACE in non-DM patients compared to DM patients. Conversely, the HEART-ECG and troponin components were not different between the DM and non-DM groups. The HEART Score demonstrates better performance in White individuals and females when contrasted with males and Black individuals. Nevertheless, these disparities do not reach statistical significance. Conclusion: The HEART Score performs differently in DM versus non-DM patients, with stronger discrimination observed in non-DM individuals. The troponin and ECG components exhibit poorer performance in diabetes mellitus (DM) patients within the context of the HEART Score. This underscores the complexity of risk assessment in DM patients with chest pain and suggests the necessity for further exploration and refinement of risk stratification strategies in this population.

Performance of Computerised Self-Reported Medical History-Taking and HEAR Score for Safe Early Rule-Out of Cardiac Events in Acute Chest Pain Patients: The CLEOS-CPDS Prospective Cohort Study

Abstract Objective A simplified version of the History, ECG, Age, Risk factors, Troponin (HEART) score, excluding troponin, has been proposed to rule out major adverse cardiac events (MACE). Computerised history taking (CHT) provides a systematic and automated method to obtain information necessary to calculate the HEAR score. We aimed to evaluate the efficacy and diagnostic accuracy of CHT in calculating the HEAR score for predicting MACE. Methods Prospective study including clinically stable adults presenting with chest pain at the emergency department of Danderyd University Hospital (Stockholm, Sweden), in 2017-2019. Participants entered their medical histories on touchscreen tablets using CHT software. HEAR and HEART scores were calculated from CHT data. 30-day MACE and ACS outcomes were retrieved, and the diagnostic accuracy was assessed. Logistic regression was used to determine the most predictive components of the HEAR score. Results Among 1,000 patients, HEART and HEAR scores could be calculated from CHT data in 648 and 666 cases, respectively, with negative predictive values (95% CI) of 0.98 (0.97–0.99) and 0.99 (0.96–1.00). Two patients with HEAR score <2 experienced a 30-day MACE. The Age (OR 2.75, 95% CI 1.62–4.66) and History (OR 2.38, 95% CI 1.52–3.71) components of the HEAR score were most predictive of MACE. ACS outcomes provided similar results. Conclusions HEAR score acquired by CHT identifies very-low risk patients with chest pain in the ED, safely ruling out ACS and MACE. This highlights the value of computerised history-taking by patients, which may reduce unnecessary tests and hospital admissions. Trial Registration ClinicalTrials.gov NCT03439449.

An Assessment of Thoracic Inlet Heart Score in Maltese Dogs with ACVIM Stage B Myxomatous Mitral Valve Disease

An Assessment of Thoracic Inlet Heart Score in Maltese Dogs with ACVIM Stage B Myxomatous Mitral Valve Disease

Identifying low-risk chest pain in out-of-hours primary care: the diagnostic performance of preHEAR and preHEART scores based on two European cohorts

Abstract Background Distinguishing cardiac from non-cardiac acute chest pain presents a diagnostic challenge. Risk stratification tools, such as the HEART score, have been developed for decision support for hospital-based settings. For prehospital settings, the preHEART score was developed as an alternative to the HEART score, with refinements made to meet prehospital conditions, as illustrated in Figure 1. While promising for use by emergency medical services, the diagnostic performance in primary care is unknown. Purpose In this study, we aim to evaluate the preHEART score (with and without high-sensitivity cardiac troponin (hs-cTn)) as a risk stratification tool to rule out acute myocardial infarction (MI) in patients evaluated in out-of-hours primary care. Methods We relied on retrospective data from two cohorts, namely, the OUT-ACS study involving 1,711 consecutive patients (47.7% female, median age: 56 (25th-75th percentiles: 45-68)) evaluated at a Norwegian primary care emergency centre from 2016-2018; and the TRACE study involving 664 consecutive patients (56.9% female, median age: 48 (25th-75th percentiles: 32-67) from a Dutch primary care emergency centre in 2017. We evaluated the preHEAR (OUT-ACS & TRACE without hs-cTn) and preHEART scores (OUT-ACS). The threshold of ≤3 points was considered low-risk and previously determined as optimal for rule-out purposes. The primary outcome was the diagnostic performance for ruling out MI at the index episode, and the secondary outcome was the composite of 90-day all-cause death or MI. Results In the OUT-ACS cohort, 61 (3.6%) patients were diagnosed with an MI; for the TRACE study, MI was diagnosed in 20 (3.0%) patients. The percentage of patients deemed at low risk by preHEAR was 49.3% (n=843) and 82.7% (n=549) for OUT-ACS and TRACE, respectively. For preHEART, only 33.6% (n=575) of OUT-ACS patients were deemed low-risk. As shown in Figure 2, the corresponding sensitivity/specificity indices for index MI were 63.9%/49.8% (OUT-ACS) and 65.0%/84.2% (TRACE) for preHEAR and 93.4%/34.6% for preHEART. Positive predictive values were low (preHEAR 5.0-11.3%, preHEART 5.0%), whereas negative predictive values were high (preHEAR 97.4-98.7%, preHEART 99.3%). For the secondary outcome, similar diagnostic performance metrics were found. All missed MI cases (n=4) in the low-risk preHEART group were female. Conclusion The preHEAR and preHEART scores did not result in adequate rule-out safety for an emergency primary care setting despite a low a priori MI risk. Moreover, the score appears to underestimate the risk for MI in females.preHEAR(T) risk scoresPerformance of the risk scores

Can a chest pain virtual ward be used to safely manage patients with low-risk acute coronary syndrome?

Abstract Background Acute coronary syndrome (ACS) accounts for approximately 2-6% of emergency department (ED) presentations and contributes at least 20% of the overall acute hospital admissions(1-3). Patients presenting with low-risk ACS may be suitable for remote monitoring(4) while awaiting angiogram in chest pain virtual ward(CPVW) thereby improving patient flow and resource utilisation. Purpose We aimed to assess outcomes for patients with low-risk ACS admitted in a district general hospital with a view to establish an onboarding pathway for CPVW whilst ensuring a safe monitoring without effecting the readmission rate or all-cause mortality. Methods We retrospectively analysed the Myocardial Ischaemia National Audit Project (MINAP) registry of from March 2022 to April 2023 for patients who presented to ED with a diagnosis of confirmed ACS. Patients were stratified into low-risk (GRACE score <140, HEART score <4, non-dynamic ECG, non-dynamic troponin, without ongoing chest pain), all other patients were deemed intermediate-to-high-risk ACS. Baseline demographics, the total length of acute admission days, waiting time before and after coronary investigation ,adverse events (escalation of therapy, death)whilst awaiting for invasive inpatient angiogram were calculated. The primary endpoint was 30-day readmission and all-cause mortality. Results 1077 patients were coded as ACS diagnosis in ED. 561(52.1%) had a confirmed diagnosis of ACS. Data to allow stratification was available for 538 patients, included in final analysis. 377(70.1%) were male with a mean age of 66.8 ± SD 13.1 years. A significant number of patients had other comorbidities, including hypertension (66.1%), diabetes (45.3%), hyperlipidaemia (51.3%), and previous history of IHD (46.5%). Total number of patients stratified into low-risk ACS was 55(10.2%), intermediate-to-high-risk group contained 483(89.8%) patients. The median total-length-of-stay (LOS) for low-risk ACS patients was 4 days(IQR 2-7), waiting time to have an inpatient angiogram was 3 days(IQR 0-5), and discharge time post-angiogram was 1 day(IQR 0-2). 4 patients(7.3%) in low-risk cohort required CCU admission for GTN infusion due to ongoing chest pain, among them 3 patients(5.5%) had abnormal coronary angiogram. 5 patients(9.1%) in low-risk cohort were readmitted due to chest pain post-angiogram and no patients had 30-days or 1-year all-cause mortality. The result depicts 51 patients from low-risk cohort would have been eligible for CPVW reducing the LOS from median 4 days to 1-2 days, this is a saving of 102-153 acute bed days per year. Assuming the costing of a bed day is £320 this equates to £32,640 - £48,960 cost saving without any adverse outcomes. Conclusion Our data suggests that there is a large cost saving with minimal risk in managing patients with low-risk ACS via a CPVW. This pathway of management is likely to have benefit in patient flow and resource utilisation in our district general hospital trust.Comparison of different ACS cohortsCPVW flow-diagram

Development of an Initial Screening Scale to Detect Patients With Chest Pain From Acute Coronary Syndrome in the Emergency Department.

Identifying patients with chest pain potentially due to acute coronary syndrome (ACS) early is crucial for triage nurses. They need a reliable, validated screening tool. This study aims to develop an initial screening scale to detect ACS in patients presenting with chest pain in the emergency department. We analyzed electronic medical records of 3131 chest pain patients from 103,041 emergency department visits between January 2018 and December 2019. ACS diagnosis was confirmed by cardiologists through clinical symptoms, electrocardiograms, and cardiac enzyme levels. The study proceeded in four stages: (1) identifying potential ACS predictors through a literature review, (2) validating these predictors with experts, (3) comparing data between ACS and non-ACS patients and (4) developing a screening scale based on identified predictors. Statistical methods included univariate analysis and binary logistic regression. The scale's accuracy was assessed using ROC curve analysis and compared to existing tools. Eight significant ACS predictors were identified: male sex, age over 49 for males and over 65 for females, typical symptoms, initial pain scale score of 6 or higher, pain duration of at least 10 min, history of ACS, hypertension, and dyslipidemia. Each predictor was scored, with typical symptoms and severe pain receiving higher scores, totaling up to 10 points. A score of 6 or more indicated high ACS risk, demonstrating accuracy comparable to the HEART and TIMI score systems. This study developed a new ACS screening scale for use by triage nurses in emergency departments. This scale can facilitate early detection and intervention for patients at high risk of ACS.

Bayesian intelligence for medical diagnosis: a pilot study on patient disposition for emergency medicine chest pain.

Clinicians can rapidly and accurately diagnose disease, learn from experience, and explain their reasoning. Computational Bayesian medical decision-making might replicate this expertise. This paper assesses a computer system for diagnosing cardiac chest pain in the emergency department (ED) that decides whether to admit or discharge a patient. The system can learn likelihood functions by counting data frequency. The computer compares patient and disease data profiles using likelihood. It calculates a Bayesian probabilistic diagnosis and explains its reasoning. A utility function applies the probabilistic diagnosis to produce a numerical BAYES score for making a medical decision. We conducted a pilot study to assess BAYES efficacy in ED chest pain patient disposition. Binary BAYES decisions eliminated patient observation. We compared BAYES to the HEART score. On 100 patients, BAYES reduced HEART's false positive rate 18-fold from 58.7 to 3.3 %, and improved ROC AUC accuracy from 0.928 to 1.0. The pilot study results were encouraging. The data-driven BAYES score approach could learn from frequency counting, make fast and accurate decisions, and explain its reasoning. The computer replicated these aspects of diagnostic expertise. More research is needed to reproduce and extend these finding to larger diverse patient populations.

A-004 Clinical and Laboratory Validation of the Atellica® vTLi Analyzer for Diagnosis of Myocardial Infarction Through High Sensitivity Cardiac Troponin I (hs-cTnI) Measurement

Abstract Background Most deaths resulting from Acute Myocardial Infarction (AMI) occur within the initial hours following the onset of clinical symptoms. Troponins serve as the preferred biomarkers and can be utilized for screening individuals presenting with chest pain, referring them towards appropriate clinical interventions based on the 0-hour/1-hour algorithm. The Atellica® vTLi Patient-side analyzer (POC), employing the methodology based Magnotech™ Technology, allows the quantification of hs-cTnI levels using a small sample volume. This capability enables the prompt evaluation and management of patients with chest pain. Use POCT troponin assays may allow for faster decision-making in this high-risk population and reduce the burden on emergency facilities. This study evaluated the analytical and clinical performance of a POCT hs-cTnI from Atellica® VTLi compared to hs-cTnT Roche Diagnostics and hs-cTnI Atellica® IM 1300. Objectives Clinical and analytical validation of the Atellica® vTLi analyzer for the measurement of hs-cTnI in patients with suspected AMI compared to the reference methodologies on the market. Methods The study is being conducted in the department of critically patient, the Cardiology program and the clinical laboratory of the Hospital Israelita Albert Einstein. In the first phase of the study, samples from 108 volunteers were analyzed for analytical comparability between hs-cTnI of the Analyzer Atellica® vTLi and hs-cTnT Cobas®. A study was then carried out of precision with samples of commercial controls with three evaluation levels, with five replicates, for 5 days in the Analyzer Atellica® vTLi. The second phase of the study was performed with samples from 51 patients who report to the emergency department with chest pain for a clinical prospective evaluation and correlation between the hs-cTnI assays of the Analyzer Atellica® vTLi, hs-cTnT Cobas® and Atellica IM 1300. Results The results show a great correlation (Pearson’s correlation greater than 0.75, p<0.0001) between the Atellica® vTLi, hs-cTnT Cobas® platforms in the sample group. Of the patients included in the second phase of study, the average age was 61 years, with 60% of patients having systemic arterial hypertension, 35% diabetics, 53% dyslipidemic patients and none of the patients were smokers. When assessing cardiovascular risk using the heart score, 55% of patients were at moderate or high risk. In this group there was also a strong correlation between the Atellica® vTLi platforms, hs-cTnT Cobas® serum, hs-cTnT Cobas® plasma, Atellica IM 1300 serum and Atellica IM 1300 plasma in the second phase (p<0.0001 in all cases. Pearson correlation), considering the reference values for laboratory stratification in the rapid chest pain protocol (time 0 h and 1 h) and the biochemical differences of troponin I and troponin T molecules. Conclusions In the present study, the Siemens POCT Atellica® vTLi device showed excellent performance in laboratory validation and strong correlation with the high-sensitivity TnT assay in different troponin concentration ranges. Additionally, Atellica® vTLi demonstrated a strong clinical correlation between hs-cTnI Atellica® IM 1300 and hs-cTnT Cobas® platforms present in a central laboratory, being considered safe for use in 0-1h protocols in patients with chest pain and suspected heart attack.

A-005 Comparison of Performance of High Sensitive Troponin I (cTNIH) by “Point of care” (POC) and Automated cTNIH Immunoassays in Patients at Low Risk of Heart Attack in a Chilean Emergency Unit; Impact on E.R Department Efficiency

Abstract Background Most cases of death from Acute Myocardial Infarction (AMI) occur in the first hours after the manifestation of clinical symptoms, constituting 40 to 65% in the first hour and approximately 80% in the first 24 hours. For the safe, effective, and rapid diagnosis of a patient with suspected AMI, international guidelines recommend that it be done based on clinical symptoms, together with electrocardiogram and analysis of biomarkers in the context of suspected of non-ST-elevation myocardial infarction (NSTEMI). Troponins are the biomarkers of choice with level A level evidence and the ability to perform screening in patients complaining of chest pain and refer it to the correct clinical approach based on the 0h/1h algorithm. To date, the successful clinical implementation of these rapid algorithms is restricted to hospitals working with well-defined workflows and a robust central laboratory structure. The Atellica® vTLi analyzer is based on the chemiluminescence methodology for the quantification of hs-cTnI levels with low sample volume, low complexity, and may enable the rapid management of patients with chest pain and application of 0h/1h algorithm. Objectives The aim of the study is to evaluate clinical performance in effectiveness and efficiency of the hs-cTnI Atellica® vTLi point of care test to rule out acute myocardial infarction in subjects with low-risk chest pain established with a validated predictive rule, in an adult-Chilean emergency unit, compared to clinical evaluation and the commonly used ADVIA Centaur® troponin test. Methods Descriptive, observational, longitudinal study. Patients over 18 years of age, consulting with acute chest pain of at least one hour from symptom onset and a HEART SCORE less than or equal to 3 points were recruited. A venous blood sample was requested for hs-cTnI analysis by Atellica® vTLi Siemens Healthineers and ADVIA Centaur® Siemens Healthineers. The time difference between sample collection and start of sample analysis; the time difference between sample collection and release of sample results was recorded and the concordance between the two results was determined. Results 50 subjects were included in the study. The difference between blood sampling and start of sample analysis was 5 minutes with Atellica® vTLi POC and 68 minutes with ADVIA Centaur®. The concordance of hs-cTnI Atellica® vTLi POC and ADVIA Centaur® was 94% for predicting medical discharge and confirmed acute myocardial infarction. Conclusions The study findings support the safety and efficiency of the hs-cTnI POC test by providing faster results than central laboratory tests with the same analytical quality, with direct impact on reducing care times in patients consulting for low-risk chest pain.

308 Provider Documentation of Patient HEART Score Following Implementation of a Non-Disruptive EHR-Driven Support Tool

308 Provider Documentation of Patient HEART Score Following Implementation of a Non-Disruptive EHR-Driven Support Tool

Rapid Acute Coronary Syndrome Evaluation Over One Hour With High-Sensitivity Cardiac Troponin I: A United States-Based Stepped-Wedge, Randomized Trial

The real-world effectiveness and safety of a 0/1-hour accelerated protocol using high-sensitivity cardiac troponin (hs-cTn) to exclude myocardial infarction (MI) compared to routine care in the United States is uncertain. The objective was to compare a 0/1-hour accelerated protocol for evaluation of MI to a 0/3-hour standard care protocol. The RACE-IT trial was a stepped-wedge, randomized trial across 9 emergency departments (EDs) that enrolled 32,609 patientsevaluated for possible MI from July 2020 through April 2021. Patients undergoing high-sensitivity cardiac troponin I testing with concentrations less than or equal to 99th percentile were included. Patients who had MI excluded by the 0/1-hour protocol could be discharged from the ED. Patients in the standard care protocol had 0- and 3-hour troponin testing and application of a modified HEART score to be eligible for discharge. The primary endpoint was the proportion of patients discharged from the ED without 30-day death or MI. There were 13,505 and 19,104 patients evaluated in the standard care and accelerated protocol groups, respectively, of whom 19,152 (58.7%) were discharged directly from the ED. There was no significant difference in safe discharges between standard care and the accelerated protocol (59.5% vs 57.8%; adjusted odds ratio (aOR)=1.05, 95% confidence interval [CI] 0.95 to 1.16). At 30 days, there were 90 deaths or MIs with 38 (0.4%) in the standard care group and 52 (0.4%) in the accelerated protocol group (aOR=0.84, 95% CI 0.43 to 1.68). A 0/1-hour accelerated protocol using high-sensitivity cardiac troponin I did not lead to more safe ED discharges compared with standard care.

18 Comparing the Accuracy of Modified HEART Scores for Risk Stratification of Low-risk Chest Pain Patients at the Emergency Department

18 Comparing the Accuracy of Modified HEART Scores for Risk Stratification of Low-risk Chest Pain Patients at the Emergency Department

349 The relationship of heart score with hot carcass weight and fat depth in Angus cattle

Abstract Congestive Heart Failure (CHF) is a cardiopulmonary condition observed in cattle raised in feedlots situated at elevations above 800 m. This condition leads to right-sided heart failure caused by increased pulmonary vessel pressures and cardiopulmonary remodeling, known as pulmonary hypertension (PH). In cattle experiencing PH, pulmonary arterial pressure (PAP) becomes abnormally high, increasing heart muscle load. This load stretches muscle fibers and enlarges the right side of the heart which can lead to heart failure and death. To assess the severity of PH, animals are assigned a heart score (HS) on a scale ranging from 1 to 5 at harvest. A score of 1 represents a normal heart, while a score of 5 indicates extreme heart remodeling. Understanding the relationship between hot carcass weight (HCW), fat depth (FD), and HS in Angus cattle will provide useful information on the impacts of this condition on feedlot performance and profitability. The objective of this study was to determine if a phenotypic relationship between HCW and FD with HS in Angus-influenced cattle. For this experiment, a total of 798 black, Angus-influenced cattle were used (245 steers, 553 heifers) that were fed near Greeley, CO. The HCW, FD, and HS data from each animal were recorded at harvest. Three general linear models were used to estimate the effects of HS on HCW and FD. Mean HCW and FD were 393.1 kg, (SD = 90.9) and 0.66 mm, (SD = 0.18), respectively, with an average HS of 2.08 (SD = 0.77). For all models, HCW and FD were fit as dependent variables, while lot and HS were included as fixed effects. Model 1 included all HS categories independently. Model 2 divided HS into 2 groups of normal (HS = 1 or 2) or remodeled (HS = 3+). For model 3 HS 3 was removed leaving only HS of 4 or 5 in the remodeled group. For both HCW and FD in Model 1, the overall effect of HS was not significant (P = 0.82 and P = 0.40, respectively). However, when comparing individual scores, animals with a HS = 4 were 15.0 kg lighter for HCW than individuals with a HS = 1 (P < 0.05). Conversely for FD, a non-significant difference (P = 0.74) of -0.33 mm was observed between animals with a HS = 4 versus a HS = 1. Grouping HS into 2 categories in Model 2 did change the outcome, yielding non-significant HCW and FD differences. However, when eliminating the HS = 3 data, a significant reduction in HCW of 16.9 kg (P = 0.05) was observed between the 2 HS groups, whereas non-significant effects on FD remained. These data suggest that at extreme levels of heart remodeling HCW may be extremely impacted negatively.

345 Breed differences within heart scores of fattening feedlot cattle

Abstract Feedlot heart disease (FHD) is a condition in fattening beef cattle that arises from right-side heart remodeling resulting from alveolar hypoxia. This hypoxic environment is hypothesized to result from the large body mass of fattened cattle. Sensitive cattle have increased incidence of pulmonary hypertension resulting from compensation mechanisms of the individual. The severity of this remodeling is quantified at harvest by gross examination of the heart utilizing a visual grading system of 1-5, where a score of 1 is a normal heart and a score of 5 is a severely remodeled heart. Previously, heart score was found to contain sire differences and to be moderately heritable. This led to more questions regarding other potential factors influencing heart scores, one of which was breed differences. Therefore, the objective of this study was to examine the prevalence of heart remodeling in beef and dairy cattle breeds and to investigate whether some breeds had a greater prevalence of heart remodeling. Heart scores were collected on Angus-influenced animals raised in the panhandle of Texas (1,103 m) and a Beef x Dairy group raised in western Kansas (846 m). The total number of animal observations was 2,069. Twenty-four percent of the individuals exhibited moderate to severe remodeling (score 3 and greater). Of this cohort, 1,307 animals had breed composition data (i.e., Angus, Simmental, Jersey, and Holstein) suitable for use in the analysis. Breed proportions ranged from 0% to 100% for Angus, 0 to 93.25% for Simmental, 0% to 69.22% for Jersey, and 0% to 78.06% for Holstein. Utilizing a linear regression model with heart score as the response and breed percentages and heart scorers as fixed effects, the importance of breed composition (covariate) was determined. The percentages of Angus influence tended to be associated with heart score (P = 0.0506), with a regression coefficient of -0.005. The percentage of Simmental had an association with the variation in heart score (P < 0.05) and had a regression coefficient of -0.008. Additionally, the percentages of Jersey and Holstein were found to reduce the incidence of heart score by a factor of -0.014 and -0.018 (P < 0.05), respectively. In summary, an increased percentage of either Jersey or Holstein breed resulted in reduced heart scores, while the incidence of beef breeds was found to be associated with some to little difference in the improvement of heart scores, alluding to potential breed advantages in mitigating right sided heart remodeling.

275 Frequency of chronic passive congestive livers at harvest in the Texas Panhandle and the association with carcass outcomes

Abstract Chronic passive congestive (CPC) livers are reported as one of the most common clinical signs of right-sided Bovine Congestive Heart Failure (BCHF). Frequency of CPC livers at harvest and the associated loss of offal and carcass value does not appear in the literature. Our objectives were to 1) quantify the frequency of CPC livers at harvest within the Texas Panhandle, and 2) evaluate the association with offal and carcass outcomes. Audits were performed over the duration of a production week (both harvest shifts) per each large commercial beef processing facility (4 total) in the Texas Panhandle. West Texas A&M University trained personnel identified CPC (large blue) livers at evisceration and documented heart score (HS; scale 1 = normal to 5 = extreme structural changes), liver weight, USDA-FSIS inspection fate (U.S. Inspected & Passed; U.S. Condemned) of the liver, remaining viscera, and carcass. Other visual observations (sex, predominant black hair coat color, carcass/visceral edema, liver abscesses) were noted. 1) Frequency data were documented among cattle-type populations: sex (steers, heifers, cows, bulls), and phenotype [native, dairy-cross, dairy, category-B (Mexico-origin)]. 2) Carcass and lot identification were collected for the purpose of tracking and obtaining carcass grading data. Of carcasses deemed wholesome-U.S. Inspected & Passed, USDA yield and quality metrics [hot carcass weight (HCW), 12th-rib fat thickness (FT), ribeye area (REA), marbling score (MS)] of those identified with CPC, as well as data for the balance of respective lots were collected. Carcass outcomes of those exhibiting a CPC liver were compared with the outcomes of remaining lot. Frequency data were analyzed via chi-square. Carcass data were analyzed using mixed models, where occurrence of CPC liver was the fixed effect; facility, cattle type, and sex were random effects. A total of 83,527 animals were audited, with a CPC liver frequency of 0.17% (n = 144). Frequencies among sex (steer = 0.16%; heifer = 0.17%; cow = 0.33%; P < 0.01) and phenotypes (native = 0.15%; category-B = 0.04%; dairy cross = 0.14%; P = 0.01) were documented. Heart scores ranged from 1 to 4, with HS 3 occurring most frequently [HS 1 (n = 2); HS 2 (n = 39); HS 3 (n = 62); HS 4 (n = 17)]. Weights of CPC livers ranged from 7.3 kg to 34.4 kg; the heaviest CPC livers were recorded in cows (mean = 17.2 kg; P < 0.01). Despite USDA-FSIS guidelines, 2.08% of CPC livers were U.S. Inspected & Passed, along with 16.90% of viscera and 84.03% of carcasses. Cow carcasses encountered the greatest U.S. Condemn-rates (38.24%) among the sex categories. Within the fed-beef population, natives were the only category resulting in U.S. Condemned carcasses (10.64%). All carcass outcomes were decreased (P ≤ 0.01) by CPC livers.

144 Assessing economic implications of thermal stress of Bos indicus and Bos taurus species during finishing in northern Colorado

Abstract The objective of this study was to determine the economic implications of thermal stress on climate adaptive capacity, resiliency, and impact of Bos indicus and Bos taurus finishing steers using common finishing systems. The experimental design was a completely randomized design, with a 2 by 2 factorial arrangement of finishing system (‘natural’ or ‘conventional’) and species of cattle (Bos indicus or Bos taurus). Steers [n = 200; body weight (BW) ~450 kg] were housed in 20 feedlot pens (10 steers/pen) for the first 84 d, where cattle were blocked by initial BW. For the remainder of the 180 d (96 d) finishing period, cattle were moved to four Climate Smart Research Pens (50 steers/pen, 1 pen/ treatment, and species combination). Within each Climate Smart Research Pen, five SmartFeed systems were used to evaluate individual animal feed intake, one GreenFeed emission measurement system was used to evaluate individual animal gas emissions flux of enteric CH4, O2, H2, and CO2, and were equipped for nutrient mass balance of carbon, nitrogen, and phosphorus. Animal BW were collected every 28 d for analysis of average daily gain (ADG) and feed efficiency. Thermal stress behaviors were evaluated by one trained personnel on a subset of 7 steers/treatment via the measurement of respiration rate, open mouth breathing, rumen temperature, number of daily water intake events, lying and standing behavior, and pen surface temperature for the last 96 d of the finishing period. At harvest, carcass characteristics, liver scores, and heart scores were collected. Economic analyses were conducted post-hoc to determine the profitability of each species based on economic implications, tradeoffs, carcass quality and quantity, and time to finish. Selection of cattle for climate adaptive features may involve production tradeoffs (e.g., depressed rate of gain, greater yield risk, lower technical efficiency) and adjustment costs (e.g., re-optimizing feed for a new breed), which affect the adoption of less common breeds into the US cattle supply chain. Adding to the complexity of this evaluation, consumers preferences may not adapt quickly, affecting the prospect of Bos indicus cuts of meat in the market. We also, therefore, explore the supply- and demand-side effects of climate change adaptation through breed selection in the beef industry.

Rapid outpatient evaluationforemergency department patientswithintermediate risk chest pain safely reduces admissions.

This study aims to assess the safety of an outpatient chest pain pathway (OCPP) for patients presenting to the emergency department (ED) with chest pain and a HEART score of 4 or 5. This is a retrospective, observational, non-inferiority study assessing the impact of the OCPP on the management and outcomes of ED patients with HEART score of 4 or 5. The study compared patients evaluated in the pre-OCPP (January‒May 2018) and the post-OCPP period (January‒October 2022). Data were collected via non-blinded chart review. The primary outcome was the rate of acute myocardial infarction (AMI) and death in patients utilizing the OCPP compared to patients with HEART score 4 or 5 in 2018. Secondary outcomes included admission rates before and after the implementation of this pathway. Non-inferiority of the post-intervention study epoch for the AMI/death composite outcome was assessed via the two one-sided tests (TOST), procedure. After implementing the OCPP, rates of patients with ED HEART score of 4 or 5 admitted from the ED decreased from 85.1% (605/711) to 74.1% (1239/1671) in 2022. Of the 432 total patients discharged in 2022, 237 (54.6%) patients were referred to emergent cardiology follow-up via the OCPP. The 30-day rate of AMI/death for patients discharged via the OCPP was 0.4% (1/237), as compared to 2.2% (8/368) in 2018. When compared to rates of AMI/death for all patients with HEART score 4 or 5 in 2018, outcomes for OCPP patients were found to be non-inferior. The OCPP resulted in non-inferior rates of AMI/death in patients with HEART scores of 4 or 5 as compared to usual care.

Use of downstream stress imaging tests for risk stratification of patients presenting to the emergency department with chest pain and low HEART score

BackgroundPatients with low HEART (History, Electrocardiogram, Age, Risk factors, and Troponin level) risk scores who are discharged from the emergency department (ED) may present clinical challenges and diagnostic dilemmas. The...

The effects of alfaxalone on cardiac and pulmonary vascular size in cats evaluated by thoracic radiography and echocardiography.

Alfaxalone is a neuroactive steroid that modulates the GABAA receptor, which has shown recent widespread use as a sedative and anesthetic agent in cats, especially in patients being screened for cardiovascular disease. This prospective, partially blinded, randomized experimental study aimed to determine if sedation with alfaxalone would alter the appearance of the cardiac silhouette or pulmonary vasculature on thoracic radiographs or echocardiographic indices of cardiac or pulmonary vascular size. Eleven apparently healthy adult cats were recruited from a research colony. Four-view thoracic radiographs and an echocardiogram were performed at baseline and following a 5mg/kg intramuscular dose of alfaxalone. Vertebral heart score (VHS) and cranial and caudal lobar pulmonary vascular measurements were obtained at both time points by two independent blinded observers, and these were analyzed using two-way ANOVA. The nonblinded echocardiographer obtained echocardiographic measurements at both time points, which were analyzed using a paired t-test or Wilcoxon signed rank test. No significant differences were identified in VHS measurements or echocardiographic parameters between baseline and sedated cats. In healthy cats, alfaxalone does not appear to significantly affect the cardiovascular structures evaluated via thoracic radiography or echocardiography.