Editor’s Capsule Summary
What is already known on this topic
The History, ECG, Age, Risk Factors, and Troponin (HEART) score has been shown to have high sensitivity in many emergency department–based studies around the world, but surveys of practicing physicians suggest it needs to be even higher (≥98%) to be used clinically.
What question this study addressed
This study confirmed the findings of a previous systematic review and also examined prespecified subgroups for whom the sensitivity of a low-risk HEART score might be higher.
What this study adds to our knowledge
After removal of studies that excluded patients with any positive troponin results, the studies that tested the modified HEART score and those that used only high-sensitivity troponins had the highest sensitivity for predicting short-term major adverse cardiac events (97% and 98%, respectively). Lower 95% confidence intervals were 96% and 91%, respectively.
How this is relevant to clinical practice
For the HEART score to be used clinically, these results suggest that future work should target the modified HEART score, high-sensitivity troponins, or both.