{"doi":"10.1002/emp2.12315","title":"Not all HEART scores are created equal: identifying “low‐risk” patients at higher risk","abstract":"OBJECTIVE: We sought to identify sub-groups of \"low-risk\" HEART score patients (history, ECG, age, risk factors, and troponin) at elevated risk of acute myocardial infarction or death within 30 days. METHODS: We performed a secondary analysis of prospective emergency department (ED) encounters for suspected acute coronary syndrome in a large health system with low-risk HEART scores (0-5 points). Logistic regression using the 5 components of the HEART score analyzed the increase risk attributable to points from each of the 5 score components. RESULTS: Of 30,971 encounters among 28,992 unique patients, 135 (0.44%, 95% confidence interval [CI] = 0.37-0.51) experienced acute myocardial infarction or death. Risk increased for each component of the HEART score from 0 to 1 to 2 points (history, 0.4% to 0.5% to 0.6%; ECG, 0.3% to 0.7% to 0.7%; age, 0.2% to 0.3% to 0.7%; risk factors, 0.1% to 0.4% to 0.8%), except troponin, which had the highest risk with 1 point (troponin, 0.4% to 2.7% to 0.9%). Odds ratios from our regression, which adjusts for other components, showed a similar pattern (from 1 vs 0 and 2 vs 0 points, respectively: history, 1.0 and 1.8; ECG, 2.2 and 3.5; age, 1.2 and 2.1; risk factors, 2.4 and 4.2; and troponin, 6.0 and 3.6). CONCLUSION: Among \"low-risk\" suspected acute coronary syndrome encounters, increasing points within each of the 5 categories demonstrated small increases in risk of death or acute myocardial infarction, with the troponin and ECG components representing the largest risk increases.","journal":"Journal of the American College of Emergency Physicians Open","year":2020,"id":115152,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":3,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.8913,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":383152,"name":"Benjamin Sun","orcid":"0000-0003-4994-5833","position":1,"is_corresponding":false},{"id":383153,"name":"Aileen Baecker","orcid":"0000-0003-4739-0870","position":2,"is_corresponding":false},{"id":383154,"name":"Rita F. Redberg","orcid":"0000-0001-6281-0250","position":3,"is_corresponding":false},{"id":383155,"name":"Ming‐Sum Lee","orcid":"0000-0001-6121-6452","position":4,"is_corresponding":false},{"id":282489,"name":"Maros Ferencik","orcid":"0000-0001-5872-2223","position":5,"is_corresponding":false},{"id":540744,"name":"Yi‐Lin Wu","orcid":"0000-0003-3758-3177","position":6,"is_corresponding":false},{"id":474751,"name":"Ernest Shen","orcid":"0000-0001-6842-9418","position":7,"is_corresponding":false},{"id":474752,"name":"Chengyi Zheng","orcid":"0000-0002-4194-0029","position":8,"is_corresponding":false},{"id":475944,"name":"Visanee V. Musigdilok","orcid":null,"position":9,"is_corresponding":false},{"id":272951,"name":"Stacy J. Park","orcid":null,"position":10,"is_corresponding":false},{"id":383158,"name":"Adam L. Sharp","orcid":"0000-0002-6736-6184","position":11,"is_corresponding":false},{"id":540743,"name":"Kimon L.H. Ioannides","orcid":"0000-0002-6384-2235","position":0,"is_corresponding":true}],"reference_count":10,"raw_metadata":null,"created_at":"2026-07-18T23:13:36.820928Z","pmid":"33392519","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}