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Modified HEART score to optimize risk stratification in cocaine-associated chest pain

Published:January 14, 2021DOI:https://doi.org/10.1016/j.ajem.2021.01.023
      We recently reported in this journal that the classification performance of the HEART score is inferior in patients presenting with cocaine associated chest pain (CACP), with 14% of those with CACP in the low risk group experiencing adverse cardiac events within 30 days of indexed admission, compared to 4% in the general chest pain population.1 This finding suggests that the HEART score, in its current form, has limited clinical utility in stratifying risk in those evaluated for CACP in the emergency department (ED). Thus, we read with great interest the correspondence letter by Holmes et al. [
      • Holmes K.A.
      • Posey R.A.
      • Wang H.
      The value of using the HEART score among cocaine associated chest pain patients in the emergency department - a closer look.
      ] about our work, and we strongly agree with their views that an improved risk tool should be derived to better stratify risk in CACP. Such improved risk stratification in this group would have immediate clinical implications to everyday practice in emergency medicine.
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