# Evaluation of Providers' Assessment of Clinical History When Using the HEART Score in the Emergency Department in the Kingdom of Saudi Arabia Hospitals: A Cross-Sectional Study

## TL;DR

This study evaluates how emergency and cardiology doctors in Saudi Arabia use the HEART score to assess chest pain patients, finding differences in how they rate risk factors and the score's subjective components.

## Contribution

The study identifies specific risk factors that are commonly overestimated or underestimated by different provider types when using the HEART score.

## Key findings

- Emergency physicians more often overestimated the historical portion of the HEART score compared to cardiologists.
- Hypercholesterolemia, smoking, and obesity were the most underestimated risk factors across both groups.
- Educational workshops are recommended to improve the accurate use of the HEART score in clinical practice.

## Abstract

Background: Emergency physicians are frequently confronted with large amounts of information, making it challenging to objectively determine the nature of diseases. Overestimation of the HEART (history, ECG, age, risk factors, and troponin) score may lead to unnecessary testing, medication, procedures, and potentially invasive tests.

Objective: This study aims to evaluate the effectiveness of emergency medicine (EM) and cardiology providers in using the HEART score.

Method: A cross-sectional study involving EM and cardiology physicians was conducted in Saudi Arabia. A questionnaire was used to collect data about participants' demographics and work-related data, experience using the HEART score in clinical practice, opinion about the tool and its most subjective component, effect of overestimation, underestimation of the historical points of the HEART score, most common underestimated and overestimated risk factors, and evaluation of the history portion of the HEART score.

Results: Most of the participants said that they used the HEART score in clinical practice and thought that it was an effective tool for risk-stratifying patients with chest pain. The most subjective components of the HEART score were risk factors, ECG assessment, and age. The most underestimated risk factors were hypercholesterolemia, smoking, and obesity, and the most overestimated were positive family history, diabetes, and high blood pressure. When comparing significant vs. mild distress, a significantly higher percentage of EM physicians overestimated the historical portion of the HEART score compared to cardiologists. A significantly higher percentage of cardiologists underestimated the historical portion of the HEART score due to a previous negative stress test, compared to cases with no prior workup and a lower versus a higher socioeconomic status (SES). ED physicians were also significantly more likely than cardiologists to use the HEART score in clinical practice and to believe that it is a useful tool for risk-stratifying patients with chest pain. According to cardiologists, the most subjective component of the HEART score was the patient's age, whereas it was risk factors for ED physicians. Patient death following a complication was the most objective effect of underestimated historical suspicion during clinical practice for cardiologists, whereas obesity or hypercholesterolemia was the most objective effect for ED physicians. Diabetes and a positive family history were the most underestimated risk factors for cardiologists, while smoking and hypercholesterolemia were the most overestimated. Obesity and hypercholesterolemia were the most underestimated risk factors for ED physicians, while hypertension (HTN), diabetes, and a positive family history were the most overestimated.

Conclusion: Hospitals should offer educational workshops to help providers understand the benefits of incorporating the HEART score into clinical decision-making.