{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T06:50:47Z","timestamp":1781765447996,"version":"3.54.5"},"reference-count":33,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2017,11,6]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Sex\u2010based differences in clinical presentation, pathophysiology, and outcomes of patients with acute chest pain are increasingly being recognized, but are not implemented in guidelines and clinical prediction tools. We evaluated the performance of the HEART score in women versus men, because sex\u2010based differences may exist among the algorithm's components: history, electrocardiogram, age, risk factors, and admission troponin level.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              The HEART score was retrospectively assessed in 831 women and 1084 men presenting to the emergency department with acute chest pain, assigning patients to the low\u2010, intermediate\u2010, or high\u2010risk category for the occurrence of major adverse cardiac events (MACE) within 6\u00a0weeks. MACE, consisting of myocardial infarction, coronary revascularization, and all\u2010cause death, also included events during index visit. Six\u2010week MACE rates were 2 times lower in women than men (10.0% versus 20.8%;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.01). Despite similar discriminatory accuracy of the HEART score among women and men (c\u2010statistic, 0.80 [0.75\u20130.84] versus 0.77 [0.74\u20130.81];\n              <jats:italic>P<\/jats:italic>\n              =0.43), 6\u2010week MACE rates were significantly lower in women than men across all HEART risk categories: 2.1% versus 6.5% (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.01) in the low\u2010risk category, 12.7% versus 21.3% (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.01) in intermediate\u2010risk category, and 53.1% versus 77.0% (\n              <jats:italic>P<\/jats:italic>\n              =0.02) in the high\u2010risk category. The HEART score\u2010adjusted risk ratio for men was 1.6 (1.3\u20132.0;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.01).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">The markedly higher 6\u2010week MACE risk in men across all HEART risk categories should be taken into account when using the HEART score to guide clinical decision making; early discharge with a low\u2010risk HEART score appears less safe for men than women with acute chest pain.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.116.005373","type":"journal-article","created":{"date-parts":[[2017,6,22]],"date-time":"2017-06-22T00:20:26Z","timestamp":1498090826000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":32,"title":["Sex\u2010Based Differences in the Performance of the HEART Score in Patients Presenting to the Emergency Department With Acute Chest Pain"],"prefix":"10.1161","volume":"6","author":[{"given":"Ingrid E. M.","family":"Bank","sequence":"first","affiliation":[{"name":"Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands"},{"name":"Department of Cardiology, Meander Medical Center, Amersfoort, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vince C.","family":"de Hoog","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominique P. V.","family":"de Kleijn","sequence":"additional","affiliation":[{"name":"Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands"},{"name":"Netherlands Heart Institute, Utrecht, the Netherlands"},{"name":"Surgery NUS &amp; Cardiovascular Research Institute, NUHS, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerard","family":"Pasterkamp","sequence":"additional","affiliation":[{"name":"Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands"},{"name":"Department of Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pieter A.","family":"Doevendans","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hester M.","family":"den Ruijter","sequence":"additional","affiliation":[{"name":"Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geertje","family":"Dalmeijer","sequence":"additional","affiliation":[{"name":"Julius Centrum for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thierry X.","family":"Wildbergh","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Meander Medical Center, Amersfoort, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arend","family":"Mosterd","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Meander Medical Center, Amersfoort, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leo","family":"Timmers","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199907223410402"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2015.03.261"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000116022.77781.26"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)00391-8"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000109491.66226.26"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrtlng.2015.05.008"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000351"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinternmed.2009.318"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehv320"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2014.09.017"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2013.02.078"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinternmed.2012.3698"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF03086144"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1097\/HPC.0b013e3181ec36d8"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2261-13-77"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1097\/HPC.0b013e3182953359"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2016.10.080"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehr236"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehr158"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.d4891"},{"key":"e_1_3_3_22_2","volume-title":"Definition and Diagnosis of Diabetes Mellitus and Intermediate Hyperglycaemia","author":"World Health Organization","year":"2006","unstructured":"World Health Organization . 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A modified HEART risk score in chest pain patients with suspected non\u2010ST\u2010segment elevation acute coronary syndrome. 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