Validation study of the modified HEART and HEAR scores in patients with chest pain who visit the emergency department

Aim: To validate the efficacy of the history, electrocardiogram, age, risk factors, and troponin (HEART) and history, electrocardiogram, age, and risk factors (HEAR) scores in a Japanese cohort. Methods: We used the data of patients who visited our emergency department between 1 December, 2015 and 31 May, 2017. Patients aged >= 20 years who presented with non-traumatic and undifferentiated chest pain were eligible for the study. On the basis of the total score, the patients were stratified as low risk (HEART and HEAR scores of 0-3), intermediate risk (HEART and HEAR scores of 4-6), and high risk (HEART score of 7-10 and HEAR score of 7-8). The major adverse cardiac events (MACEs) that occurred within 6 weeks were investigated, and the diagnostic value and efficiency of both scores were analyzed. Results: In total, 132 patients were included in the HEART score analysis and 220 patients in the HEAR score analysis. The incidence rates of MACEs in patients with low, intermediate, and high risks were 0%, 23.2%, and 63.6% in the HEART score analysis and 4.7%, 22.9%, and 62.5% in the HEAR score analysis (P < 0.001), respectively. The identification of MACEs in low-risk patients had a negative predictive value in the HEART score (1.00; 95% confidence interval, 0.90-1.00) and HEAR score (0.95; 95% confidence interval, 0.89-0.99) analyses. Conclusion: The modified HEART and HEAR scores were effective in identifying patients with chest pain who are at low risk of MACEs at an emergency department in Japan.