Comparison of prehospital and in-hospital HEART scores in patients with possible myocardial infarction

Chest pain suspicious for myocardial infarction is a common reason for ambulance transfer to hospital where the HEART score may be used to identify those at low risk and potentially suitable for early discharge.1 The HEART score combines the history, electrocardiogram, age, risk factors, and cardiac troponin with each component allocated 0, 1, or 2 points and scores of ≤3, 4–6, and ≥7 considered low, intermediate, and high risk, respectively.1 Data pertaining to the HEAR components of the score are routinely collected by paramedics in the prehospital setting.2, 3 Recent studies suggest paramedics may be able to use the HEART score to manage some low-risk patients without direct hospital transfer.4, 5 This is attractive, with intuitive benefits for patients, ambulance services, and emergency departments (EDs).

However, prospective studies of the reliability of the HEART score between different grades of clinicians have demonstrated variable results in hospital,6, 7 as have two studies that have involved paramedics.8, 9 A better understanding of the factors that influence risk assessment in the prehospital setting is necessary to ensure robust decision making and comparable safety to rule-out myocardial infarction as in the ED.10