Study to Validate the Accuracy of Hearts 3 Score in Risk Stratifying Chest Pain in the Emergency Room

Narayanee, R (2019) Study to Validate the Accuracy of Hearts 3 Score in Risk Stratifying Chest Pain in the Emergency Room. Masters thesis, Kilpauk Medical College, Chennai.


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BACKGROUND: Chest pain is one of the commonest presentations at the Emergency Room. About 15-25% of the patients presenting with chest pain have Acute Coronary Syndrome. Acute Coronary Syndrome includes the spectrum from Unstable Angina, Non ST Elevation Myocardial Infarction and ST Elevation Myocardial Infarction. There is Universal definition for the diagnosis for STEMI, whereas, the diagnosis Unstable angina and NSTEMI have no diagnostic criteria, but when missed, may proceed onto STEMI. There was a need for an objective scoring system to triage chest pain patients who are likely having NSTE ACS, in the emergency room. Then, the HEART Score was formulated in 2008 and it was well validated. But it had some shortcomings, which were offset by the Ehrlanger HEARTS3 Score. HEARTS3 Score was found to be more efficient than its forerunner- the HEART Score. This study is to validate the HEARTS3 Score by prospective study. AIM AND OBJECTIVES: AIM: The aim of my study is to risk stratify Non ST elevation chest pain patients in the Emergency Room using HEARTS3 Score, so that high risk patients can be evaluated and low risk patients can be discharged early, so that the resources need not be spent in evaluating all patients. OBJECTIVES: The objective of my study is to 1. Determine the association between the HEARTS3 score and outcome in the form of Major Adverse Cardiac Event such as Myocardial Infarction, Cardiogenic shock, Cardiac arrest, all cause cardiac death upto 7 days in all patients presenting with non ST Elevation chest pain to the Emergency Room and 2. Validate the accuracy of the HEARTS3 Score in risk stratifying such patients. MATERIALS AND METHODS: This is a prospective observational study carried on at Government Kilpauk Medical College Hospital, on 100 patients who are 18 years or older, presenting with chest pain to the emergency room. STEMI patients are excluded from the study. HEARTS3 Score is framed for each patient and the patients are observed for 7 days for the occurrence of MACE in the form of Myocardial Infarction, Cardiogenic shock, Cardiac arrest and all cause cardiac death. RESULTS: In this study, patients with score >16 were 42, of whom all 42 patients had MACE, accounting for a specificity of 100%. Of the 100 patients, 44 patients had MACE of whom, 42 patients had score >16, accounting for sensitivity of 95.45% (42/44). The Positive Predictive Value for MACE for scores >16 was 100 and the Negative Predictive Value was 96.55. CONCLUSION: HEARTS3 Score is an efficient score in triaging acute chest pain patients at the Emergency Room. Patients with score more than 16 are more likely to have acute coronary syndrome and may be managed in Coronary Care Unit and those with lower scores may be planned for early discharge, hence avoiding the generalised use of cardiac monitoring for all patients with chest pain, hence decreasing cost and patient anxiety.

Item Type: Thesis (Masters)
Additional Information: Reg.No.201611157
Uncontrolled Keywords: Chest pain triage, HEART S3 Score.
Subjects: MEDICAL > General Medicine
Depositing User: Subramani R
Date Deposited: 25 Aug 2019 08:11
Last Modified: 25 Aug 2019 08:11

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