• Ronald Check, Brian Kelly, Erica Dunn, Holly Stankewicz, Jenna Hakim, Kate Arner, Kylie Ridley, Jennifer Irick, Michael Irick, Darin Agresti, and Rebecca Jeanmonod.
• St. Luke's University Hospital and Health Network, Department of Emergency Medicine, Bethlehem, PA, United States of America.
• Am J Emerg Med. 2022 Jan 1; 51: 308-312.

IntroductionThe HEART score is a widely used clinical decision tool that provides emergency providers with objective risk stratification for patients presenting to the emergency department (ED) with undifferentiated chest pain (CP). There is no data as to which patients undergo formal risk stratification with a HEART score, and whether patient demographics influence decisions to apply the HEART score. Our objective was to determine if sex or race independently predict documentation of patients' HEART scores in CP patients.MethodsThis is a retrospective cohort study of all patients with a chief complaint of CP who presented to EDs within a single health care system (11 EDs) from September 2018-January 2021. Charts were identified via query of the electronic medical record, and patient age, race, and sex were extracted. The presence or absence of documentation of a HEART score was also recorded. Patient race was categorized as white/non-white. Sex was categorized as male/female. Age was inputted as a continuous variable. We performed logistic regression to determine which variables were associated with documentation of a HEART score.Results38,277 patients were included in the study. The median patient age was 51 with IQR 36-64, and 18,927 (47.5%) were male. HEART scores were documented in 24,181. Younger age, female sex, and non-white race were all independent predictors of not having HEART score risk stratification documented in the medical record.ConclusionsWomen and non-white patients are less likely to receive HEART score risk stratification when presenting with undifferentiated CP, even when controlling for patient age. Further studies should address whether this influences patient centered outcomes.Copyright © 2021 Elsevier Inc. All rights reserved.

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