{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:37:12Z","timestamp":1760027832991,"version":"3.40.5"},"reference-count":37,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2019,12,23]],"date-time":"2019-12-23T00:00:00Z","timestamp":1577059200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Key R&D Program of China","award":["2017YFC0908700","2017YFC0908703"],"award-info":[{"award-number":["2017YFC0908700","2017YFC0908703"]}]},{"name":"National S&T Fundamental Resources Investigation Project","award":["2018FY100600","2018FY100602"],"award-info":[{"award-number":["2018FY100600","2018FY100602"]}]},{"name":"Key R&D Program of Shandong Province","award":["2016ZDJS07A14","2018GSF118003"],"award-info":[{"award-number":["2016ZDJS07A14","2018GSF118003"]}]},{"name":"Taishan Pandeng Scholar Program of Shandong Province","award":["tspd20181220"],"award-info":[{"award-number":["tspd20181220"]}]},{"name":"Taishan Young Scholar Program of Shandong Province","award":["tsqn20161065","tsqn201812129"],"award-info":[{"award-number":["tsqn20161065","tsqn201812129"]}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Cardiology"],"published-print":{"date-parts":[[2020,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Triage decisions for chest pain patients receiving usual care are based on a dynamic and comprehensive strategy performed in the physician's mind. It remains controversial whether simple, structured risk tools can surpass real, complex judgments.<\/jats:p><\/jats:sec><jats:sec><jats:title>Hypothesis<\/jats:title><jats:p>The potentially used History, Electrocardiogram, Age, Risk factors, Troponin (HEART) score would help identify low\u2010risk patients for discharge.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients with acute, non\u2010traumatic chest pain managed according to usual care were consecutively enrolled in a tertiary university hospital in China from August 24, 2015 to September 30, 2017. Major adverse cardiac events (MACE) included death, acute myocardial infarction, revascularization, and significant coronary stenosis (&gt;50%) within 30\u2009days. We compared the efficacy and safety of usual care and the potentially used HEART score in this population.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 2185 patients analyzed, 926 (42.4%) patients were directly discharged by usual care, whereas HEART\u22643 would have identified 524 (24.0%) patients as low\u2010risk (<jats:italic>P<\/jats:italic> &lt;\u2009.001). The MACE rate in discharged patients was 2.2% (20\/926) and would have been 5.2% (27\/524) in those with HEART\u22643 (<jats:italic>P<\/jats:italic> =\u2009.002). For discharged patients, the MACE rates in HEART\u22643 vs HEART&gt;3 groups were not significantly different (1.5% vs 2.7%, <jats:italic>P<\/jats:italic> =\u2009.225). Negative predictive value (NPV) was higher with usual care than with the HEART score (<jats:italic>P<\/jats:italic> =\u2009.003), but sensitivity was similar. For 340 patients with serial troponins, usual care was superior to the potentially used HEART score in regard to efficacy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>At this institution, usual care identified many more patients for discharge than the HEART score would have without apparently different outcomes in discharged patients with lower vs higher HEART scores. The HEART score would not appear to provide helpful risk stratification.<\/jats:p><\/jats:sec>","DOI":"10.1002\/clc.23325","type":"journal-article","created":{"date-parts":[[2019,12,23]],"date-time":"2019-12-23T08:55:23Z","timestamp":1577091323000},"page":"371-378","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Comparison of usual care and the HEART score for effectively and safely discharging patients with low\u2010risk chest pain in the emergency department: would the score always help?"],"prefix":"10.1002","volume":"43","author":[{"given":"Guangmei","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine and Chest Pain Center Qilu Hospital of Shandong University  Jinan China"},{"name":"Clinical Research Center for Emergency and Critical Care Medicine of Shandong Province, Institute of Emergency and Critical Care Medicine of Shandong University Qilu Hospital of Shandong University  Jinan China"},{"name":"Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Key Laboratory of Cardiopulmonary\u2010Cerebral Resuscitation Research of Shandong Province Qilu Hospital of Shandong University  Jinan China"},{"name":"The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese Ministry of Health and Chinese Academy of Medical Sciences; The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine Qilu Hospital of Shandong University  Jinan China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1098-0490","authenticated-orcid":false,"given":"Wen","family":"Zheng","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine and Chest Pain Center Qilu Hospital of Shandong University  Jinan China"},{"name":"Clinical Research Center for Emergency and Critical Care Medicine of Shandong Province, Institute of Emergency and Critical Care Medicine of Shandong University Qilu Hospital of Shandong University  Jinan China"},{"name":"Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Key Laboratory of Cardiopulmonary\u2010Cerebral Resuscitation Research of Shandong Province Qilu Hospital of Shandong University  Jinan China"},{"name":"The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese Ministry of Health and Chinese Academy of Medical Sciences; The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine Qilu Hospital of Shandong University  Jinan China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shuo","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine and Chest Pain Center Qilu Hospital of Shandong University  Jinan China"},{"name":"Clinical Research Center for Emergency and Critical Care Medicine of Shandong Province, Institute of Emergency and Critical Care Medicine of Shandong University Qilu Hospital of Shandong University  Jinan China"},{"name":"Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Key Laboratory of Cardiopulmonary\u2010Cerebral Resuscitation Research of Shandong Province Qilu Hospital of Shandong University  Jinan China"},{"name":"The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese Ministry of Health and Chinese Academy of Medical Sciences; The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine Qilu Hospital of Shandong University  Jinan China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jingjing","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine and Chest Pain Center Qilu Hospital of Shandong University  Jinan China"},{"name":"Clinical Research Center for Emergency and Critical Care Medicine of Shandong Province, Institute of Emergency and Critical Care Medicine of Shandong University Qilu Hospital of Shandong University  Jinan China"},{"name":"Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Key Laboratory of Cardiopulmonary\u2010Cerebral Resuscitation Research of Shandong Province Qilu Hospital of Shandong University  Jinan China"},{"name":"The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese Ministry of Health and Chinese Academy of Medical Sciences; The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine Qilu Hospital of Shandong University  Jinan China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"He","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine and Chest Pain Center Qilu Hospital of Shandong University  Jinan China"},{"name":"Clinical Research Center for Emergency and Critical Care Medicine of Shandong Province, Institute of Emergency and Critical Care Medicine of Shandong University Qilu Hospital of Shandong University  Jinan China"},{"name":"Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Key Laboratory of Cardiopulmonary\u2010Cerebral Resuscitation Research of Shandong Province Qilu Hospital of Shandong University  Jinan China"},{"name":"The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese Ministry of Health and Chinese Academy of Medical Sciences; The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine Qilu Hospital of Shandong University  Jinan China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiaqi","family":"Zheng","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine and Chest Pain Center Qilu Hospital of Shandong University  Jinan China"},{"name":"Clinical Research Center for Emergency and Critical Care Medicine of Shandong Province, Institute of Emergency and Critical Care Medicine of Shandong University Qilu Hospital of Shandong University  Jinan China"},{"name":"Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Key Laboratory of Cardiopulmonary\u2010Cerebral Resuscitation Research of Shandong Province Qilu Hospital of Shandong University  Jinan China"},{"name":"The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese Ministry of Health and Chinese Academy of Medical Sciences; The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine Qilu Hospital of Shandong University  Jinan China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiali","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine and Chest Pain Center Qilu Hospital of Shandong University  Jinan China"},{"name":"Clinical Research Center for Emergency and Critical Care Medicine of Shandong Province, Institute of Emergency and Critical Care Medicine of Shandong University Qilu Hospital of Shandong University  Jinan China"},{"name":"Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Key Laboratory of Cardiopulmonary\u2010Cerebral Resuscitation Research of Shandong Province Qilu Hospital of Shandong University  Jinan China"},{"name":"The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese Ministry of Health and Chinese Academy of Medical Sciences; The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine Qilu Hospital of Shandong University  Jinan China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4670-3727","authenticated-orcid":false,"given":"Feng","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine and Chest Pain Center Qilu Hospital of Shandong University  Jinan China"},{"name":"Clinical Research Center for Emergency and Critical Care Medicine of Shandong Province, Institute of Emergency and Critical Care Medicine of Shandong University Qilu Hospital of Shandong University  Jinan China"},{"name":"Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Key Laboratory of Cardiopulmonary\u2010Cerebral Resuscitation Research of Shandong Province Qilu Hospital of Shandong University  Jinan China"},{"name":"The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese Ministry of Health and Chinese Academy of Medical Sciences; The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine Qilu Hospital of Shandong University  Jinan China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9501-2546","authenticated-orcid":false,"given":"Yuguo","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine and Chest Pain Center Qilu Hospital of Shandong University  Jinan China"},{"name":"Clinical Research Center for Emergency and Critical Care Medicine of Shandong Province, Institute of Emergency and Critical Care Medicine of Shandong University Qilu Hospital of Shandong University  Jinan China"},{"name":"Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Key Laboratory of Cardiopulmonary\u2010Cerebral Resuscitation Research of Shandong Province Qilu Hospital of Shandong University  Jinan China"},{"name":"The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese Ministry of Health and Chinese Academy of Medical Sciences; The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine Qilu Hospital of Shandong University  Jinan China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2019,12,23]]},"reference":[{"key":"e_1_2_9_2_1","first-page":"1","article-title":"Emergency department summary","volume":"2010","author":"Niska R","year":"2007","journal-title":"Natl Health Stat Report"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2006.08.005"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/1745-6215-11-57"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200004203421603"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2015.1674"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2006.03.025"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.1031315"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jemermed.2010.11.036"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehv320"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000134"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hlc.2016.06.789"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2013.01.255"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2016.07.147"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2016.10.080"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2012.10.010"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/acem.12860"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.7326\/M16-1600"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF03086144"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.284.7.835"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.163.19.2345"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.114.001384"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2013.11362"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1136\/emermed-2014-203798"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2018.12.013"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0b013e3182831a11"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1742-6723.2010.01256.x"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2014.12.018"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehs184"},{"key":"e_1_2_9_30_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2288-13-91"},{"key":"e_1_2_9_31_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1553-2712.2009.00470.x"},{"key":"e_1_2_9_32_1","doi-asserted-by":"publisher","DOI":"10.1136\/emermed-2014-203832"},{"key":"e_1_2_9_33_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.116.021886"},{"key":"e_1_2_9_34_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12471-012-0322-6"},{"key":"e_1_2_9_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2007.10.034"},{"key":"e_1_2_9_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2012.09.171"},{"key":"e_1_2_9_37_1","doi-asserted-by":"publisher","DOI":"10.1177\/2048872617710788"},{"key":"e_1_2_9_38_1","doi-asserted-by":"publisher","DOI":"10.1002\/clc.23177"}],"container-title":["Clinical Cardiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fclc.23325","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/clc.23325","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/clc.23325","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/clc.23325","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,6]],"date-time":"2023-09-06T03:11:56Z","timestamp":1693969916000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/clc.23325"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,12,23]]},"references-count":37,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2020,4]]}},"alternative-id":["10.1002\/clc.23325"],"URL":"https:\/\/doi.org\/10.1002\/clc.23325","archive":["Portico"],"relation":{},"ISSN":["0160-9289","1932-8737"],"issn-type":[{"type":"print","value":"0160-9289"},{"type":"electronic","value":"1932-8737"}],"subject":[],"published":{"date-parts":[[2019,12,23]]},"assertion":[{"value":"2019-11-01","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-12-12","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-12-23","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}