Date Posted: June 9, 2026

Author/s: Julie Ann Raquepo Davalos, MD

Objective: Different risk stratifying tools are available among patients presenting with a non-traumatic chest pain at the emergency department. Thus, validation of their potential utility is important.

Objective: This study aimed to determine the validity of the HEART scoring system in predicting outcome in patients who present with chest pain at the emergency department of a private tertiary hospital.

Methods: This is a chart review study that included adult patients who presented with non-traumatic chest pain at the emergency department from January 2020 to March 2021. Medical charts of patients were included using total enumeration sampling strategy. Demographic profile as well as components of the HEART score were extracted from available data sources. Patients were stratified based on their total HEART score: low risk (≤ 3 points), intermediate risk (4-6 points), and high risk (7-10 points). Presence or absence of any of the MACE within 30 days following the index event were also assessed. Extended Chi-square, Fisher’s Exact Test, or Student’s T Test were used to compare baseline characteristic variables. Fisher’s Exact Test was used to determine association between HEART risk stratification and MACE status. Association between the specific MACE and risk stratification was also determined using Fisher’s Exact Test. Area under the ROC curve (AUC), also known as the C-statistic was generated to determine the discriminative power of the HEART score based on the different cut-off points.

Results: A total of 121 patients were included mostly older males (63.64%) with different comorbidities and almost 72% have MACE. Significantly higher proportion of patients without MACE was noted among the patients with low and intermediate risk while all patients with high risk were all noted to have MACE (p<0.0001). Using a cutoff value of ≥ 5 points, the positive and negative predictive value (95% CI) were 98.9% (93.8-100.0%) and 97.1% (84.7-99.9%), respectively. The area under the curve (AUC) using the cutoff value of ≥ 5 was 0.9795 (0.9486 – 1.0000) with an overall accuracy of 98.35%.

Conclusion: Based on the set cut off points of the HEART score for the occurrence of MACE, the authors were able to demonstrate its utility in this institution by risk stratifying the patients.

Keywords:
HEART score, major adverse coronary events (MACE), non-traumatic chest pain