SIGNIFICANCE OF HEART SCORE IN PATIENTS PRESENTING WITH CHEST PAIN IN THE EMERGENCY DEPARTMENT

Abstract

Background: Chest pain is a common emergency department presentation and requires rapid assessment to identify patients at risk for acute coronary syndrome. The HEART score, which incorporates history, ECG findings, age, risk factors, and troponin levels, is a validated tool for predicting major adverse cardiac events. However, data on its performance in South Asian populations, especially in Pakistan, where cardiovascular risk factors are widespread, remain limited. Objective: Our findings underscore the importance of the HEART score in predicting 30-day cardiac events, reassuring clinicians of its value in patient care in Pakistan. Study Design: Descriptive analytical study. Settings: Emergency Department, Shifa International Hospital, Islamabad. Duration of Study: May 2024 to March 2025. Methods: A total of 240 adult patients presenting with non-traumatic chest pain were enrolled using consecutive sampling. Patients with ST elevation myocardial infarction, traumatic chest pain, hemodynamic instability, or incomplete clinical data were excluded. HEART scores were calculated for all participants and categorised into low-risk (0–3), intermediate-risk (4–6), and high-risk (7–10) groups. The primary outcome was the occurrence of 30-day major adverse cardiac events, defined as myocardial infarction, coronary revascularisation, or cardiac death. Data were analysed using chi-square testing and crude odds ratios with 95% confidence intervals. Results: The mean age of participants was 54.1 ± 13.0 years, and 62.1% were male. Hypertension (52.1%), diabetes mellitus (35.8%), and dyslipidemia (30.8%) were the most prevalent risk factors. Based on HEART score stratification, 35.8% of patients were classified as low risk, 45.8% as intermediate risk, and 18.3% as high risk. Overall, 30-day major adverse cardiac events occurred in 18.8% of the cohort. Event rates increased significantly across HEART score categories, occurring in 2.3% of low-risk, 18.2% of intermediate-risk, and 52.3% of high-risk patients (χ² = 47.71, p < 0.001). Compared with the low-risk group, the crude odds of major adverse cardiac events were significantly higher in the intermediate-risk group (odds ratio 9.33, 95% confidence interval 2.12–41.15) and the high-risk group (odds ratio 46.00, 95% confidence interval 10.04–210.74). Conclusion: The HEART score's effective risk stratification supports its role in optimizing resource use, helping emergency teams feel more capable of managing patient flow efficiently.