Chest pain is one of the most common presentations to the emergency department (ED) and HEART score (history, ECG, age, risk factors, and cardiac troponin) is recommended for risk stratification. It has been proposed that the sum of four items with no troponin (HEAR score) below 2 can be used safely to lower testing and reduce length of stay. To assess the performance of the HEAR score in hospital and prehospital settings, we performed a systematic review and meta-analysis. English studies on the performance of the HEAR score in patients with acute chest pain were included. They were excluded if data are inaccessible. MEDLINE, Embase, Evidence-Based Medicine Reviews, Scopus, and web of science were searched from 1946 to July 2021. The quality of studies was assessed using Quality Assessment of Diagnostic Accuracy Studies version 2. Acute coronary syndrome or major adverse cardiac events prediction were outcomes of interest. The performance indices with 95% confidence intervals (CIs) were extracted. Inverse variance and the random-effects model were used to report the results. Of the 692 articles on the HEAR score, 10 studies were included in the analysis with 33 843 patients. Studies were at low to moderate risk of bias. Three studies were in prehospital and three were retrospective. The pooling of data on the HEAR score showed that the sensitivity at the HEAR<2, <3, and <4 cutoffs in the ED were 99.03% (95% CI, 98.29-99.77), 97.54% (95% CI, 94.50-100), and 91.80% (95% CI, 84.62-98.98), respectively. The negative predictive values (NPVs) for the above cutoffs were 99.84% (95% CI, 99.72-99.95), 99.75% (95% CI, 99.65-99.85), and 99.57% (95% CI, 99.11-100), respectively. Of note, for the HEAR<2, negative likelihood ratio was 0.07 (95% CI, 0.02-0.12). In the prehospital, at the HEAR<4 cutoff, the pooled sensitivity and NPV were 85.01% (95% CI, 80.56-89.47) and 91.48% (95% CI, 87.10-95.87), respectively. This study showed that in the ED, the HEAR score<2 can be used for an early discharge strategy. Currently, this score cannot be recommended in prehospital setting. Prospero (CRD42021273710).

中文翻译：

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HEAR 评分在识别低风险胸痛方面的表现：系统评价和荟萃分析。

胸痛是急诊科 (ED) 最常见的症状之一，建议使用 HEART 评分（病史、心电图、年龄、危险因素和心肌肌钙蛋白）进行风险分层。有人提出，无肌钙蛋白（HEAR 评分）低于 2 的四项总和可安全使用，以降低检测次数并缩短住院时间。为了评估 HEAR 评分在医院和院前环境中的表现，我们进行了系统评价和荟萃分析。纳入了关于急性胸痛患者 HEAR 评分表现的英国研究。如果无法访问数据，则将其排除在外。从 1946 年到 2021 年 7 月检索了 MEDLINE、Embase、Evidence-Based Medicine Reviews、Scopus 和 web of science。研究质量使用诊断准确性研究质量评估第 2 版进行评估。急性冠脉综合征或主要不良心脏事件预测采用兴趣的结果。提取具有 95% 置信区间 (CI) 的性能指数。使用逆方差和随机效应模型来报告结果。在 692 篇关于 HEAR 评分的文章中，分析纳入了 10 项研究，涉及 33 843 名患者。研究存在低至中等偏倚风险。三项研究是院前研究，三项是回顾性研究。HEAR 评分数据的汇总显示，急诊科 HEAR<2、<3 和 <4 临界点的敏感性分别为 99.03%（95% CI，98.29-99.77）、97.54%（95% CI，94.50- 100）和 91.80%（95% CI，84.62-98.98）。上述截止值的阴性预测值 (NPV) 分别为 99.84% (95% CI, 99.72-99.95)、99.75% (95% CI, 99.65-99.85) 和 99.57% (95% CI, 99.11-100) 。值得注意的是，对于 HEAR<2，阴性似然比为 0.07（95% CI，0.02-0.12）。在院前，在 HEAR<4 截止值时，汇总敏感性和 NPV 分别为 85.01% (95% CI, 80.56-89.47) 和 91.48% (95% CI, 87.10-95.87)。本研究表明，在急诊室，HEAR 评分<2 可用于早期出院策略。目前，在院前环境中不推荐使用此评分。普洛斯彼罗 (CRD42021273710)。