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September 8, 2026International Emergency NursingOpen Access

HEART score strongly predicts MACE, identifying low-risk patients with event rates below ~2%.

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Why the study?

Does the HEART score provide reliable risk stratification and improve management for adults with acute chest pain presenting to the emergency department?

Population

Adults with acute chest pain presenting to the emergency department (15 studies from 7 countries)

Design

Systematic_review

Key result

The HEART score demonstrates strong predictive performance for major adverse cardiac events, with consistently low event rates (0-2%) among low-risk patients.

Authors

MGMary O' GradyBLBarbara Lloyd

Discussion

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Member takes

Overview

Supports safe early discharge of low-risk ED chest pain patients; confirms robust performance across systematic review evidence.

Key Points

  • Synthesize evidence on healthcare practitioners' use of the HEART score for risk stratification and clinical management of adults presenting to emergency departments with acute chest pain.
  • Conducted a scoping review adhering to JBI methodology and PRISMA-ScR guidelines across six databases (CINAHL, Medline, SCOPUS, PubMed, Embase, and GreyLit) from January 2015 to January 2025.
  • Screened studies using the Population-Concept-Context framework and extracted data independently in duplicate regarding study characteristics, score utilization, and patient outcomes.
  • Identified 15 studies across seven countries demonstrating high overall inter-operator reliability, with the strongest agreement seen in objective metrics (age, troponin) and lower agreement in subjective history.
  • The score exhibited robust predictive capability for major adverse cardiac events (MACE), with event rates between 0% and 2% in low-risk patients compared to substantially higher rates in intermediate- and high-risk groups.
  • Adoption of the HEART pathway reduced hospital admissions and diagnostic testing without compromising clinical outcomes, though clinician adherence varied with frequent over-admission of low-risk patients.

Structured PICO

Does the HEART score provide reliable risk stratification and improve management for adults with acute chest pain presenting to the emergency department?

P
Population
Adults with acute chest pain presenting to the emergency department evaluated across 15 studies.
E
Exposure
HEART score for risk stratification and management
O
Outcome
Healthcare practitioners' use of the HEART score, inter-operator reliability, predictive performance for MACE, and impact on hospitalizations and diagnostic testing

The HEART score is a reliable and effective tool for risk-stratifying ED patients with chest pain, safely identifying low-risk patients for early discharge and reducing unnecessary hospitalizations, though its full potential is limited by variable clinician adherence.

Limitations

  • Variability in clinician adherence, particularly among less experienced practitioners, may limit its full potential
  • Variability in clinician adherence, particularly among less experienced practitioners

Cite This Study

Grady et al. (2026) conducted a review in Acute chest pain. HEART score was evaluated on Major adverse cardiac events (MACE). The HEART score demonstrates strong predictive performance for major adverse cardiac events, with consistently low event rates (0-2%) among low-risk patients.

synapsesocial.com/papers/6a9fd78a58e84d0ff5b4648ahttps://doi.org/10.1016/j.ienj.2026.101893
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Improving chest pain risk assessment: validation of HEART, TIMI, GRACE, EDACS-ADP, and HET for MACE prediction in the emergency department2025 · 7 citations
  2. 2Predictive Performance of the HEART Score for Acute Coronary Syndrome with Significant Coronary Stenosis in Patients with Non–ST-Elevation Acute Chest Pain2026
  3. 3Clinical Characteristics, Risk Score Distribution, and Hospitalization Status in Emergency Department Patients with Acute Chest Pain: A Single-Center Retrospective Four-Year Study2026 · 1 citations
  4. 4Analysis of patients presenting with chest pain in the emergency department using laboratory parameters and scoring in the prediction of acute coronary syndrome hospitalization2025
  5. 5Clinical Decision Rules for Heart Failure Management in Acute Emergency Department Settings2025