{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T11:18:19Z","timestamp":1787829499234,"version":"build-2784847793"},"reference-count":45,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2024,2,23]],"date-time":"2024-02-23T00:00:00Z","timestamp":1708646400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["K23\u2010HL155500"],"award-info":[{"award-number":["K23\u2010HL155500"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000061","name":"Fogarty International Center","doi-asserted-by":"publisher","award":["D43TW009337"],"award-info":[{"award-number":["D43TW009337"]}],"id":[{"id":"10.13039\/100000061","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100016545","name":"Roche Diagnostics","doi-asserted-by":"publisher","award":["SUB\u2010000347"],"award-info":[{"award-number":["SUB\u2010000347"]}],"id":[{"id":"10.13039\/100016545","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007619","name":"Society for Academic Emergency Medicine","doi-asserted-by":"publisher","award":["AG2020\u2010092"],"award-info":[{"award-number":["AG2020\u2010092"]}],"id":[{"id":"10.13039\/100007619","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Academic Emergency Medicine"],"published-print":{"date-parts":[[2024,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>The HEART score successfully risk stratifies emergency department (ED) patients with chest pain in high\u2010income settings. However, this tool has not been validated in low\u2010income countries.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This is a secondary analysis of a prospective observational study that was conducted in a Tanzanian ED from January 2019 through January 2023. Adult patients with chest pain were consecutively enrolled, and their presenting symptoms and medical history were recorded. Electrocardiograms and point\u2010of\u2010care troponin assays were obtained for all participants. Thirty\u2010day follow\u2010up was conducted, assessing for major adverse cardiac events (MACEs), defined as death, myocardial infarction, or coronary revascularization (coronary artery bypass grafting or percutaneous coronary intervention). HEART scores were calculated for all participants. Likelihood ratios, sensitivity, specificity, and negative predictive values (NPVs) were calculated for each HEART cutoff score to predict 30\u2010day MACEs, and area under the curve (AUC) was calculated from the receiver operating characteristic curve.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 927 participants with chest pain, the median (IQR) age was 61 (45.5\u201374.0) years. Of participants, 216 (23.3%) patients experienced 30\u2010day MACEs, including 163 (17.6%) who died, 48 (5.2%) with myocardial infarction, and 23 (2.5%) with coronary revascularization. The positive likelihood ratio for each cutoff score ranged from 1.023 (95% CI 1.004\u20131.042; cutoff \u2265\u20091) to 3.556 (95% CI 1.929\u20136.555; cutoff \u2265\u20097). The recommended cutoff of \u22654 to identify patients at high risk of MACEs yielded a sensitivity of 59.4%, specificity of 52.8%, and NPV of 74.7%. The AUC was 0.61.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Among patients with chest pain in a Tanzanian ED, the HEART score did not perform as well as in high\u2010income settings. Locally validated risk stratification tools are needed for ED patients with chest pain in low\u2010income countries.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acem.14872","type":"journal-article","created":{"date-parts":[[2024,2,24]],"date-time":"2024-02-24T07:39:24Z","timestamp":1708760364000},"page":"361-370","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Evaluating the performance of the <scp>HEART<\/scp> score in a Tanzanian emergency department"],"prefix":"10.1111","volume":"31","author":[{"given":"Braylee","family":"Grisel","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine Duke University Medical Center  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olanrewaju","family":"Adisa","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Duke University Medical Center  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francis M.","family":"Sakita","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Kilimanjaro Christian Medical Centre  Moshi Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tumsifu G.","family":"Tarimo","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Kilimanjaro Christian Medical Centre  Moshi Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Godfrey L.","family":"Kweka","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Kilimanjaro Christian Medical Centre  Moshi Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jerome J.","family":"Mlangi","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Kilimanjaro Christian Medical Centre  Moshi Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amedeus V.","family":"Maro","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Kilimanjaro Christian Medical Centre  Moshi Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marilyn","family":"Yamamoto","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Duke University Medical Center  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren","family":"Coaxum","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Duke University Medical Center  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Arthur","sequence":"additional","affiliation":[{"name":"Duke Global Health Institute Duke University  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9822-5595","authenticated-orcid":false,"given":"Alexander T.","family":"Limkakeng","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Duke University Medical Center  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7396-4789","authenticated-orcid":false,"given":"Julian T.","family":"Hertz","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Duke University Medical Center  Durham North Carolina USA"},{"name":"Duke Global Health Institute Duke University  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,2,23]]},"reference":[{"key":"e_1_2_11_2_1","first-page":"1","article-title":"Emergency department visit rates by selected characteristics: United States, 2019","volume":"434","author":"Cairns C","year":"2022","journal-title":"NCHS Data Brief"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0002-9149(97)00422-0"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11845-012-0826-5"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.2003.027599"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.5334\/gh.403"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.5334\/gh.402"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.15420\/aer.2017.24.1"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000001030"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/HPC.0b013e3181ec36d8"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/bf03086144"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/HPC.0b013e3182315a85"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2013.01.255"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1161\/jaha.118.010541"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/acem.13649"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1161\/circulationaha.107.720953"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-227X-15-S2-S13"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.120.021107"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1161\/jaha.121.021004"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2020.05.017"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.5830\/cvja-2015-036"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)32203-7"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.h5527"},{"key":"e_1_2_11_24_1","unstructured":"About Us.Kilimanjaro Christian Medical Centre.2023. Accessed September 25 2023.https:\/\/www.kcmc.ac.tz\/about"},{"key":"e_1_2_11_25_1","unstructured":"2022 Population and Housing Census \u2013 Administrative Units Population Distribution and Age and Sex Distribution Reports. Tanzania National Bureau of Statistics2022. Accessed October 1 2023.https:\/\/www.nbs.go.tz\/nbs\/takwimu\/Census2022\/Administrative_units_Population_Distribution_Report_Tanzania_volume1a.pdf"},{"key":"e_1_2_11_26_1","unstructured":"Tanzania \u2014 Ethnic Groups.The University of Pennsylvania African Studies Center. Accessed October 1 2023.https:\/\/www.africa.upenn.edu\/NEH\/tethnic.htm"},{"key":"e_1_2_11_27_1","volume-title":"Cardiology Magazine","author":"Medical Missions in Tanzania: Creating a Sustainable Health Care Infrastructure","year":"2015"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1093\/inthealth\/ihz061"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0212139"},{"key":"e_1_2_11_30_1","doi-asserted-by":"publisher","DOI":"10.1161\/circoutcomes.121.008528"},{"key":"e_1_2_11_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2021.08.002"},{"key":"e_1_2_11_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.afjem.2021.07.002"},{"key":"e_1_2_11_33_1","doi-asserted-by":"publisher","DOI":"10.7326\/M16-1600"},{"key":"e_1_2_11_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2019.01.003"},{"key":"e_1_2_11_35_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0189264"},{"key":"e_1_2_11_36_1","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.114.04394"},{"key":"e_1_2_11_37_1","doi-asserted-by":"publisher","DOI":"10.1016\/s2213-8587(16)30181-4"},{"key":"e_1_2_11_38_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(16)31012-1"},{"key":"e_1_2_11_39_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1553-2712.2002.tb02191.x"},{"key":"e_1_2_11_40_1","doi-asserted-by":"publisher","DOI":"10.3978\/j.issn.2223-3652.2015.08.01"},{"key":"e_1_2_11_41_1","doi-asserted-by":"publisher","DOI":"10.4103\/1117-1936.165488"},{"key":"e_1_2_11_42_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2021.02.007"},{"key":"e_1_2_11_43_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2023.03.016"},{"key":"e_1_2_11_44_1","doi-asserted-by":"publisher","DOI":"10.1111\/acem.13665"},{"key":"e_1_2_11_45_1","doi-asserted-by":"publisher","DOI":"10.1161\/circoutcomes.114.001384"},{"key":"e_1_2_11_46_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0226892"}],"container-title":["Academic Emergency Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/acem.14872","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,4,12]],"date-time":"2024-04-12T05:50:23Z","timestamp":1712901023000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/acem.14872"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2,23]]},"references-count":45,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2024,4]]}},"alternative-id":["10.1111\/acem.14872"],"URL":"https:\/\/doi.org\/10.1111\/acem.14872","archive":["Portico"],"relation":{},"ISSN":["1069-6563","1553-2712"],"issn-type":[{"value":"1069-6563","type":"print"},{"value":"1553-2712","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,2,23]]},"assertion":[{"value":"2023-11-05","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-01-08","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-02-23","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}