Validity of the “HEART” Score as an Early Assessment Tool in Acute Coronary Syndrome in a Sri Lankan Population: A Single Centre Pilot Study

Objectives The HEART score is a clinical tool used for early risk stratification in patients presenting with chest pain in emergency settings, which facilitates prognostication. Although limited, it has been validated in several countries throughout the world. This study aimed to assess the validity of HEART score, in a Sri Lankan population, as an early assessment tool, for risk prediction of acute coronary syndrome (ACS), in patients presenting with chest pain.

Data was collected from 74 patients presenting to the emergency department at a tertiary care centre in Sri Lanka. HEART score was calculated for each patient retrospectively and patients were categorized into low (0-3), intermediate (4-6), and high (7-10) risk groups. The predictive accuracy of the HEART score with a diagnosis of ACS and the occurrence of major adverse cardiac events (MACE) at 6 weeks was assessed. Statistical analysis was performed using R studio.

All patients in the low-risk group (n=8) were correctly identified as non-ACS, with no MACE. All high-risk patients (n=29) had ACS and experienced MACE. Among the intermediate risk group (n=37), 70.3% were diagnosed with ACS and 54% developed MACE at 6 weeks. Area under curve (AUC) for HEART score for a diagnosis of ACS, was 0.889 (95% CI: 0.8171-0.9609) while the AUC for occurrence of MACE was 0.9053 (95% CI: 0.8437 - 0.9669).

The HEART score is an effective early assessment tool which can be used in Sri Lankans, in prediction of the probability of ACS, and MACE within 6 weeks, in patients presenting with chest pain. Competing Interest Statement The authors have declared no competing interest. Funding Statement This study did not receive any funding Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethics Review Committee of Faculty of Medicine, University of Kelaniya gave ethical approval for this work. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data Availability All data produced in the present study are available upon reasonable request to the authors Abbreviations - ACS - Acute coronary syndrome - ECG - Electrocardiography - hs-cTn I - High-sensitivity cardiac troponin - I ED - Emergency department - MACE - Major adverse cardiac events - PCI - Percutaneous coronary interventions - CABG - Coronary artery bypass grafting - STEMI - ST-elevation myocardial infarction - NSTEMI - non-ST elevated myocardial - AMI - Acute myocardial infarction - PPV - Positive predictive value - NPV - negative predictive value - AUC-ROC - area under the receiver operating characteristic curve - IHD - Ischemic heart disease - CAD - Coronary artery disease - CKD - Chronic kidney disease - COPD - Chronic obstructive pulmonary disease - GORD - Gastro-oesophageal reflux disease - PND - Paroxysmal nocturnal dyspnoea