We performed a methodological appraisal of the history, electrocardiogram, age, risk factors,
and troponin (HEART) score and its variants in the context of Annals of Emergency
Medicine's methodological standards for clinical decision rules. We note that this chest pain
risk stratification tool was not formally derived, omits sex and other known predictors, has
weak interrater reliability, and its 0, 1, and 2 score weightings do not align with their known
predictivities. Its summary performance (pooled sensitivities of 96% to 97% with lower …

We appreciate the interest Green and Schriger 1 have taken in chest pain risk stratification.
Prior to the use of the HEART score and HEART Pathway, most US emergency departments
(EDs) admitted up to 80% of their patients with chest pain. 2 The HEART score and Pathway
revolutionized chest pain care by providing a safe method of early discharge. It may be easy
to forget, or for those new to emergency medicine to not even realize, how far we have come
in a short period of time and how this progress was made. The HEART Pathway randomized …