Research ArticleORIGINAL RESEARCH
Open Access

HEART Score Agreement Between Attending and Resident Emergency Medicine Physicians for Patients With Potential Acute Coronary Syndrome

Joel C. Mosley, Greggory R. Davis and Michael H. Truax
Ochsner Journal May 2025, DOI: https://doi.org/10.31486/toj.24.0108

Article Figures & Data

Figures

  • Figure 1.
    Figure 1.

    A HEART score standardized form derived from Six et al1 was used in phase 2 of the study. BMI, body mass index; CAD, coronary artery disease; HEART, history, electrocardiogram, age, risk factors, troponin; LVH, left ventricular hypertrophy; N/V, nausea/vomiting; y.o., years old.

  • Figure 2.
    Figure 2.

    Heatmap of attending physician vs resident physician HEART scores. The y-axis represents resident HEART scores, and the x-axis represents attending HEART scores. For each patient, the HEART scores by the attending and the resident were tallied on the heatmap (eg, a HEART score of 2 by the attending and 2 by the resident were tallied as 1 comparison in the box corresponding to 2 on the y-axis and 2 on the x-axis). The number inside each box represents the frequency of those comparisons. More frequent occurrences are represented by darker boxes, and less frequent occurrences are represented by lighter boxes. Key differences, depicted by red-bordered boxes, indicate instances in which the HEART score was ≤3 for the attending and >3 for the resident, or vice versa. Any box without a border did not fall into this category. HEART, history, electrocardiogram, age, risk factors, troponin.

  • Figure 3.
    Figure 3.

    Heatmap of attending physician vs resident physician HEART scores for (A) phase 1 and (B) phase 2 of the study. The y-axis represents resident HEART scores, and the x-axis represents attending HEART scores. For each patient, the HEART scores by the attending and the resident were tallied on the heatmap (eg, a HEART score of 2 by the attending and 2 by the resident were tallied as 1 comparison in the box corresponding to 2 on the y-axis and 2 on the x-axis). The number inside each box represents the frequency of those comparisons. More frequent occurrences are represented by darker boxes, and less frequent occurrences are represented by lighter boxes. Key differences, depicted by red-bordered boxes, indicate instances in which the HEART score was ≤3 for the attending and >3 for the resident, or vice versa. Any box without a border did not fall into this category. HEART, history, electrocardiogram, age, risk factors, troponin.

  • Figure 4.
    Figure 4.

    HEART subscore differences for phase 2 of the study. For each component of the overall HEART score, the attending physician score was subtracted from the resident physician score. The x-axis shows the subject numbers of the patients who were scored. The y-axis represents the absolute difference in the subscores. Each subscore is coded by a unique color. ECG, electrocardiogram. HEART, history, electrocardiogram, age, risk factors, troponin.

  • Figure 5.
    Figure 5.

    Standardized linear regression assessing the relationship between HEART score differences and study phase (phase 1 vs phase 2). HEART, history, electrocardiogram, age, risk factors, troponin.

Tables

  • Table 1.

    Attending Physician and Resident Physician Experience Levels

    Attending Physician Experience Level, yearsAttending Physicians, n=75Resident Physician Experience Level, yearsResident Physicians, n=75
    0-222 (29.3)PGY17 (9.3)
    3-519 (25.3)PGY230 (40.0)
    6-1020 (26.7)PGY337 (49.3)
    >1012 (16.0)PGY4+1 (1.3)
    Missing2 (2.7)

    • Note: Data are presented as n (%). Experience levels that were not recorded are reported as missing.

    • PGY, postgraduate year.

  • Table 2.

    Attending Physician vs Resident Physician HEART Scores

    HEART ScoreAttending Physician FrequencyResident Physician Frequency
    02 (2.7)0
    16 (8.0)7 (9.3)
    28 (10.7)8 (10.7)
    311 (14.7)8 (10.7)
    416 (21.3)16 (21.3)
    514 (18.7)21 (28.0)
    612 (16.0)8 (10.7)
    73 (4.0)6 (8.0)
    82 (2.7)0
    91 (1.3)1 (1.3)
    Total75 (100)75 (100)

    • Notes: From the original 77 HEART score forms collected, an attending physician HEART score was missing for 1 patient, and a component of the HEART score was missing from both the attending and resident physician for another patient that prevented direct score comparisons for 2 patients. This table reflects only complete comparisons (n=75 per group). Data are presented as n (%).

    • HEART, history, electrocardiogram, age, risk factors, troponin.

  • Table 3.

    Logistic Regression for HEART Scores ≤3 or >3

    PredictorOdds Ratio95% Confidence Interval
    Study phase0.25<0.01-1,031.89
    Attending physician years of experience1.180.78-1.81
    Resident physician years of experience0.770.38-1.53

    • HEART, history, electrocardiogram, age, risk factors, troponin.

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