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. 2018 Dec;35(12):732-738.
doi: 10.1136/emermed-2018-207540. Epub 2018 Sep 14.

Do all HEART Scores beat the same: evaluating the interoperator reliability of the HEART Score

William G P Niven  1 , David Wilson  1 , Steve Goodacre  2 , Alexander Robertson  1 , Samira Jane Green  1 , Tim Harris  3
Affiliations

Do all HEART Scores beat the same: evaluating the interoperator reliability of the HEART Score

William G P Niven et al. Emerg Med J. 2018 Dec.

Abstract

Background: Patients presenting with chest pain represent a significant proportion of attendances to the ED. The History, ECG, Age, Risk Factors and Troponin (HEART) Score is validated for the risk stratification of suspected ischaemic chest pain within the ED. The goal of this research was to establish the interoperator reliability of the HEART Score as performed in the ED by different grades of doctor and nurse.

Methodology: Patients with suspected ischaemic chest pain presenting to the ED of an inner city, London Hospital, were recruited prospectively between January and May 2016. Patients that had been enrolled in the study were interviewed by clinicians from four different categories: senior doctor, junior doctor, senior nurse and junior nurse. Clinicians, blinded to other raters' results, calculated the HEART Scores for each patient with the assistance of a pocket-sized HEART Score card. The intraclass correlation coefficient (ICC) was calculated as the primary measure of reliability. 120 patients were required to achieve a desired power of 80%.

Results: 88 complete comparisons were obtained. There were no significant differences between the distributions of HEART Scores for each clinician group (p=0.95). The ICC for the overall HEART Score was 0.91 (95% CI 0.87 to 0.93). The ICC for troponin and age were '1', for 'history' 0.41 (95% CI 0.30 to 0.52), 'ECG' 0.64 (95% CI 0.54 to0.73) and 'risk factors' 0.84 (95% CI 0.79 to 0.89).

Conclusion: This study demonstrates very strong overall interoperator reliability between the four groups of clinicians studied. This suggests that the HEART Score is reproducible when used by different professional groups and grade of clinician.

Keywords: cardiac care, diagnosis; chest - non trauma; emergency care systems, emergency departments; management, risk management; nursing, emergency departments.

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Conflict of interest statement

Competing interests: Dr Niven reports grants from Royal College of Emergency Medicine, during the conduct of the study; and I have collaborated with Dr Barbra Backus, one of the original developers of the HEART Score, in creating a teaching video for the HEART Score.

Figures

Figure 1
Figure 1
Flow diagram for the recruitment of patients into the trial. HEART, History, ECG, Age, Risk Factors and Troponin.
Figure 2
Figure 2
History, ECG, Age, Risk Factors and Troponin (Heart) Score for each grade of rater (patients ordered by average score). JD, junior doctor; JN, junior nurse; SD senior doctor; SN, senior nurse.
Figure 3
Figure 3
Intraclass correlation coefficients (ICCs) for the History, ECG, Age, Risk Factors and Troponin score.
See this image and copyright information in PMC

References

    1. Six AJ, Backus BE, Kelder JC. Chest pain in the emergency room: value of the HEART score. Neth Heart J 2008;16:191–6. 10.1007/BF03086144 - DOI - PMC - PubMed
    1. Backus BE, Six AJ, Kelder JC, et al. A prospective validation of the HEART score for chest pain patients at the emergency department. Int J Cardiol 2013;168:2153–8. 10.1016/j.ijcard.2013.01.255 - DOI - PubMed
    1. Backus BE, Six AJ, Kelder JC, et al. Chest pain in the emergency room: a multicenter validation of the HEART Score. Crit Pathw Cardiol 2010;9:164–9. 10.1097/HPC.0b013e3181ec36d8 - DOI - PubMed
    1. Antman EM, Cohen M, Bernink PJLM, et al. The TIMI risk score for unstable Angina/Non–ST elevation MI. JAMA 2000;284:835–42. 10.1001/jama.284.7.835 - DOI - PubMed
    1. Fox KA, Dabbous OH, Goldberg RJ, et al. Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndrome: prospective multinational observational study (GRACE). BMJ 2006;333:1091–4. 10.1136/bmj.38985.646481.55 - DOI - PMC - PubMed

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