HEART Score Agreement Between Attending and Resident Emergency Medicine Physicians for Patients With Potential Acute Coronary Syndrome.

Abstract

Background: Chest pain in the emergency department requires swift diagnosis to distinguish between acute coronary syndrome and noncardiac causes. The use of the HEART score, which risk-stratifies patients based on history, electrocardiogram, age, risk factors, and troponin, reduces unnecessary admissions and costs. However, evaluations by resident physicians supervised by attending physicians can delay treatment and increase costs.

Methods: We assessed interrater reliability between attending physician and resident physician HEART scores in 2 study phases. In phase 1, participants were not provided with a standardized form, but in phase 2, participants used a standardized form to calculate HEART scores. Differences in scores were compared by years of experience and by study phase.

Results: A total of 75 HEART score comparisons were analyzed. Fifty comparisons between attending physicians and resident physicians were completed in phase 1, and 25 comparisons were completed in phase 2. Discrepancies between attending and resident physician scores ≤3 vs >3 decreased from 24% in phase 1 to 8% in phase 2. Attending physician years of experience did not affect discrepancies in HEART scores ≤3 vs >3 between attending and resident physicians (odds ratio [OR] 1.18 [95% CI 0.78 to 1.81]). Similarly, resident physician years of experience did not affect differences in HEART scores ≤3 vs >3 between attending and resident physicians (OR 0.77 [95% CI 0.38 to 1.53]).

Conclusion: The study found good agreement between attending physician and resident physician HEART scores, with experience level not significantly affecting discrepancies. The standardized scoring form improved consistency, although not significantly.