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Multicenter observational study on the reliability of the HEART score

Clinical and Experimental Emergency Medicine 2019년 6권 3호 p.212 ~ 217
 ( Parenti Nicola ) - University Hospital of Modena Emergency Department

 ( Lippi Giuseppe ) - University of Verona Section of Clinical Biochemistry
 ( Reggiani Maria Letizia Bacchi ) - University of Bologna Emergency Department
 ( Luciani Antonio ) - University Hospital of Modena Emergency Department
 ( Cavazza Mario ) - University of Bologna Emergency Department
 ( Pietrangelo Antonello ) - University Hospital of Modena Internal Department
 ( Vegetti Alberto ) - University Hospital of Modena Internal Department
 ( Brugioni Lucio ) - University Hospital of Modena Emergency Department
 ( Bonfanti Laura ) - University Hospital of Parma Emergency Department
 ( Cervellin Gianfranco ) - University Hospital of Parma Emergency Department


Objective: To rapidly and safely identify the risk of developing acute coronary syndrome in patients with chest pain who present to the emergency department, the clinical use of the History, Electrocardiogram, Age, Risk Factors, and Troponin (HEART) scoring has recently been proposed. This study aimed to assess the inter-rater reliability of the HEART score calculated by a large number of Italian emergency physicians.

Methods: The study was conducted in three academic emergency departments using clinical scenarios obtained from medical records of patients with chest pain. Twenty physicians, who took the HEART score course, independently assigned a score to different clinical scenarios, which were randomly administered to the participants, and data were collected and recorded in a spreadsheet by an independent investigator who was blinded to the study’s aim.

Results: After applying the exclusion criteria, 53 scenarios were finally included in the analysis. The general inter-rater reliability was good (kappa statistics [κ], 0.63; 95% confidence interval, 0.57 to 0.70), and a good inter-rater agreement for the high- and low-risk classes (HEART score, 7 to 10 and 0 to 3, respectively; κ, 0.60 to 0.73) was observed, whereas a moderate agreement was found for the intermediate-risk class (HEART score, 4 to 6; κ, 0.51). Among the different items of the HEART score, history and electrocardiogram had the worse agreement (κ, 0.37 and 0.42, respectively).

Conclusion: The HEART score had good inter-rater reliability, particularly among the high- and low-risk classes. The modest agreement for history suggests that major improvements are needed for objectively assessing this component.


HEART score; HEART pathway; Chest pain; Acute coronary syndrome; Emergency service, hospital
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