Inter-rater Reliability of the HEART Score

Background The HEART score is a risk stratification tool for suspected acute coronary syndrome and contains several subjective components. A single previous study found good inter-rater reliability. Our objective was to assess the inter-rater reliability of the HEART score in an external prospective cohort. Methods We prospectively collected paired, independent physician ratings of the HEART score for patients > 20 years of age presenting to the emergency department with chest pain for which an ECG and troponin were ordered. Two emergency physicians independently provided HEART scores for each unique patient. The primary outcome, the HEART score, was dichotomized by low risk (0–3) vs non- low risk (4–10). Additional outcomes included the HEART score across the entire scale (0–10) and subcomponents of the HEART score (e.g., history, electrocardiogram, risk factors; score of 0–2 for each). We calculated kappa statistics and percent agreement for all outcomes. Results We collected paired physician HEART score ratings on 311 patients from October 2017 to April 2018. The mean HEART score was 3.5 (SD 1.9). About half (49.2%) of our patients had a HEART score of ≤ 3, and 50.8% had a HEART score > 3. The kappa score for “low risk” (HEART ≤ 3) was 0.68 (95%CI: 0.60 – 0.77). There was 84.2% agreement between physicians on this variable. Conclusions Our study demonstrates there is substantial inter-rater reliability among emergency department physicians in identifying patients at low risk of acute coronary syndrome using the HEART score.