CHEST PAIN OUTPATIENT STRESS TEST PROGRAM

HEART SCORE: Risk stratification scoring that has been prospectively and retrospectively validated for risk stratifying patients at risk for coronary artery disease and the rate of Major Adverse Cardiac Events (MACE) defined as myocardial infarction, positive catheterization or intervention, CABG, or Death.

Category / Item / Points / Patient Score
History / Highly Suspicious / 2
Moderately Suspicious / 1
Slightly Suspicious / 0
ECG / Significant ST-deviation / 2
Nonspecific repolarization / 1
Normal / 0
Age / >65 Years Old / 2
>45 and <65 Years Old / 1
<45 years old / 0
Risk Factors / ≥3 risk factors or history or known disease / 2
1 or 2 risk factors / 1
No risk factors known / 0
Troponin / ≥ 3 times the normal limit / 2
>1 and <3 times the normal limit / 1
≤1 times the normal limit / 0
Total Score:

Risk Factors for Atherosclerotic Disease: Hypercholesterolemia, Smoking, Hypertension, Diabetes, Positive Family History, Obesity

Score Interpretation: The initial study classified three categories of risk:

0-3 points = 2.5% MACE over next 6 weeks, consider close outpatient workup

4-6 points = 20.3% MACE over next 6 weeks, consider inpatient observation for testing

7-10 points = 72.7% MACE over next 6 weeks, consider early invasive strategies

Additional Studies: Prospective US and European Studies have shown a MACE rate between 0.6% and 1.7% for Low Risk (HEART Score Less than 3) patients in other studies.

CHEST PAIN OUTPATIENT STRESS TEST PROGRAM

Chest Pain Basics

  • Chest pain is a common presentation, yet 75-85% of all chest pain is not related to the heart
  • No good ED test to completely rule out cardiac disease
  • Historically admitted most patients to the hospital

HEART Score

  • Scoring system for risk stratification of patients
  • Validated in the ED Population
  • Supported by the TeamHealth Patient Safety Organization

Patient Decision Making

Based upon the review of the clinical information and risk stratification as discussed with my provider, I understand that I am a low risk patient based upon the HEART Score. While no plan can be completely free of risk, I prefer to:

□Have a second Troponin (blood test) and be discharged for follow up outpatient stress testing within 72 hours.

□Be observed in the hospital for further testing at the direction of the Hospitalist.

______

Name:

Date: