Integration of focused cardiac ultrasound in the HEAR and HEART scores in emergency department patients with chest pain

Chest pain (CP) is a common emergency department (ED) presenting symptom, requiring rapid assessment for acute coronary syndrome (ACS). The HEAR and HEART scores have been proposed to streamline patient evaluation. This study evaluated whether adding Focused Cardiac Ultrasound (FoCUS) could enhance risk stratification. Analysis of a prospective observational study involving adult patients at the ED of a University Hospital in Italy in 2022. Patients were stratified by the HEAR score into low (≤ 1) and mid-high risk (≥ 2) groups, and HEART score into low (≤ 3), mid (4-6), and high-risk (≥ 7) groups. All patients underwent FoCUS for regional wall motion abnormalities (RWMA). The primary outcome was non-ST-elevation (NSTE)-ACS within 30 days. We included 684 patients with median age of 58 years and 40% females. NSTE-ACS occurred in 106 (16%) patients, with 0/123 (0%) and 106/561 (19%) in low and mid-high-risk HEAR groups, respectively, and 6/337 (2%), 63/278 (23%) and 37/69 (54%) in low, mid and high-risk HEART groups, respectively. RWMA was found in 87 (13%) patients. In HEAR ≥ 2 (53% vs 13%, p < 0.001) and HEART 4-6 patients (50% vs 17%, p < 0.001), RWMA were associated with a higher frequency of NSTE-ACS. Multivariable analysis confirmed RWMA as an independent predictor of NSTE-ACS (OR 3.10, 95%CI 1.66-5.78). Including RWMA into the HEART score increased its sensitivity for high-risk patients (0.54 vs 0.35).Integrating RWMA identified by FoCUS into the HEAR and HEART scores might improve risk stratification for NSTE-ACS in patients presenting to the ED with chest pain.