HEART Theses

  1. The HEART score for chest pain patients, B.E. Backus, 2012.
  2. Risk stratification for chest pain patients, J.M. Poldervaart, 2016.

Literature on the HEART Score

Since 2008, numerous articles on the HEART score have been published. See the list below for all the references from the study team of the HEART score from the Netherlands, as well as a list of literature from other study teams across the world.

The Netherlands

  1. Impact of using the HEART score in chest pain patients at the emergency department: a stepped wedge, cluster randomized trial. Judith M. Poldervaart MD, PhD; Johannes B. Reitsma MD, PhD; Barbra E. Backus MD, PhD; Hendrik Koffijberg PhD; Rolf F Veldkamp MD, PhD; Monique E. ten Haaf MD, Yolande Appelman MD, PhD; MD; Herman F.J. Mannaerts MD, PhD; Jan-Melle van Dantzig MD, PhD; Madelon van den Heuvel MD; Mohamed el Farissi MD; Bernard J.W.M. Rensing MD, PhD; Nicolette M.S.K.J. Ernst MD, PhD; Ineke M.C. Dekker MD; Frank R. den Hartog MD; Thomas Oosterhof MD, PhD; Ghizelda R. Lagerweij; Eugene M. Buijs MD, PhD; Maarten W.J. van Hessen MD, PhD; Marcel A.J. Landman MD; Roland R.J. van Kimmenade MD, PhD; Luc Cozijnsen MD; Jeroen J.J. Bucx MD, PhD; Clara E.E. van Ofwegen-Hanekamp MD, PhD; Maarten-Jan Cramer MD, PhD; A. Jacob Six MD, PhD; Pieter A. Doevendans MD, PhD; Arno W. Hoes MD, PhD. Annals of Internal Medicine. 2017, epub ahead of print.
  2. Comparison of the GRACE, HEART and TIMI score to predict major adverse cardiac events in chest pain patients at the emergency department. J.M. Poldervaart, M. Langedijk, B.E. Backus, I.M.C. Dekker, A.J. Six, P.A. Doevendans, A.W. Hoes, J.B. Reitsma. Int J Cardiol. 2016 Oct 30. doi: 10.1016/j.ijcard.2016.10.080.
  3. Medical consumption compared for TIMI and HEART score in chest pain patients at the emergency department: a retrospective cost analysis. A Nieuwets, JM Poldervaart, JB Reitsma, S Buitendijk, A J Six,B E Backus, AW Hoes, PA Doevendans. BMJ Open 2017.
  4. Prognostic Factors in Chest Pain Patients. A Quantitative Analysis of the HEART Score. Barbra E. Backus, A. Jacob Six, Pieter A. Doevendans, Johannes C. Kelder, Ewout W. Steyerberg, Yvonne Vergouwe. Crit Pathways in Cardiol 2016;15: 50–55.
  5. A prospective validation of the HEART score for chest pain patients at the emergency department. BE Backus, AJ Six, JC Kelder, MAR Bosschaert, EG Mast, A Mosterd, RF Veldkamp, AJ Wardeh, R Tio, R Braam SHJ Monnink, R van Tooren, TP Mast, F van den Akker, MJM Cramer, AW Hoes, PA Doevendans. International Journal of Cardiology. 2013;168(3):2153-8.
  6. The impact of the HEART risk score in the early assessment of patients with acute chest pain: design of a stepped wedge, cluster randomised trial. Poldervaart JM, Reitsma JB, Koffijberg H, Backus BE, Six AJ, Doevendans PA, Hoes AW. BMC Cardiovasc Disord. 2013;13:77.
  7. The HEART score for the assessment of patients with chest pain in the Emergency Department: A multi-national validation study. A Jacob Six, Louise Cullen, Barbra E Backus, Jaimi Greenslade, William Parsonage, Sally Aldous, Pieter A Doevendans, Martin Than. Critical Pathways in Cardiology. 2013;12: 121–126.
  8. The predictive value of the exercise ECG for major adverse cardiac events in patients who presented with chest pain in the emergency department. Poldervaart JM, Six AJ, Backus BE, de Beaufort HW, Cramer MJ, Veldkamp RF, Gijs Mast E, Buijs EM, Tietge WJ, Groenemeijer BE, Cozijnsen L, Wardeh AJ, den Ruiter HM, Doevendans PA. Clinical Research in Cardiology 2013;102(4):305-12.
  9. The value of clinical and laboratory diagnostics for chest pain patients at the emergency department. Jellema LJ, Backus BE, Six AJ, Braam R, Groenemeijer B, van der Zaag-Loonen HJ, Tio R, van Suijlen JD. Clin Chem Lab Med. 2013 Aug 12:1-8.
  10. Risk scores for patients with chest pain: evaluation in the Emergency Department. B. E. Backus, A. J. Six, J. H. Kelder, W. B. Gibler, F. L. Moll and P. A. Doevendans. Current Cardiology Reviews 2011; 7(1); 2-8.
  11. Consumption of diagnostic procedures and other cardiology care in chest pain patients after presentation at the emergency department. Six AJ, Backus BE, Kingma A, Kaandorp SI. Netherlands Heart Journal 2012;20(12); 409-504.
  12. Chest pain in the emergency room: value of the HEART score. A.J. Six, B.E. Backus, J.C. Kelder. Neth Heart J 2008;16:191-6.A.J.


  1. Adherence to an Accelerated Diagnostic Protocol for Chest Pain: Secondary Analysis of the HEART Pathway Randomized Trial. Mahler SA, Riley RF, Russell GB, Hiestand BC, Hoekstra JW, Lefebvre CW, et al. Acad Emerg Med 2016;23(1): 70-7.
  2. The HEART Pathway randomized trial: identifying emergency department patients with acute chest pain for early discharge. Mahler SA, Riley RF, Hiestand BC, Russell GB, Hoekstra JW, Lefebvre CW, et al. Circ Cardiovasc Qual Outcomes 2015; 8(2): 195-203.
  3. Identifying Patients Suitable for Discharge After a Single-Presentation High-Sensitivity Troponin Result: A Comparison of Five Established Risk Scores and Two High-Sensitivity Assays. Carlton EW, Khattab A, Greaves K. Ann Emerg Med 2015; pii: S0196-0644(15)00583-1.
  4. Identifying patients for early discharge: performance of decision rules among patients with acute chest pain. Mahler SA, Miller CD, Hollander JE, Nagurney JT, Birkhahn R, Singer AJ, et al. Int J Cardiol 2013; 168(2): 795-802.
  5. HEART score: a simple and useful tool that may lower the proportion of chest pain patients who are admitted. Melki D, Jernberg T. Crit Pathw Cardiol 2013; 12(3): 127-31.
  6. Can the HEART score safely reduce stress testing and cardiac imaging in patients at low risk for major adverse cardiac events? Mahler SA, Hiestand BC, Goff DC Jr, Hoekstra JW, Miller CD. Crit Pathw Cardiol 2011; 10(3): 128-33.
  7. Comparison of the HEART and TIMI Risk Scores for Suspected Acute Coronary Syndrome in the Emergency Department. Benjamin C. Sun, Amber Laurie, Rongwei Fu, Maros Ferencik, Michael Shapiro, Christopher J. Lindsell, Deborah Diercks, James W. Hoekstra,Judd E. Hollander, J. Douglas Kirk, W. Frank Peacock, Venkataraman Anantharaman, Charles V. Pollack jr. Crit Pathways in Cardiol 2016;15: 1–5.
  8. Association of Early Stress Testing with Outcomes for Emergency Department Evaluation of Suspected Acute Coronary Syndrome. Benjamin C. Sun, MD, MPP, Amber Laurie, MS, Rongwei Fu, PhD, Maros Ferencik, MD, PhD, Michael Shapiro, MD, Christopher J. Lindsell, PhD, Deborah Diercks, MD, James W. Hoekstra, MD, Judd E. Hollander, J. Douglas Kirk, W. Frank Peacock, W. Brian Gibler, Venkataraman Anantharaman, Charles V. Pollack Jr.
  9. Chest Pain Risk Scores Can Reduce Emergent Cardiac Imaging Test Needs With Low Major Adverse Cardiac Events Occurrence in an Emergency Department Observation Unit. Hao Wang, MD, PhD, Katherine Watson, RN, BSN, Richard D. Robinson, MD, Kristina H. Domanski, MBBS, BSc, Johnbosco Umejiego, MBBS, MPH, Layton Hamblin, DO, Sterling E. Overstreet, MD, Amanda M. Akin, DO, Steven Hoang, Meena Shrivastav, PhD, Michael Collyer, PhD, Ryan N. Krech, MD, JD, Chet D. Schrader, MD, and Nestor R. Zenarosa, MD. Crit Pathways in Cardiol 2016;15: 145–151.
  10. Addition of heart score to high-sensitivity troponin T versus conventional troponin T in risk stratification of patients with chest pain at the coronary emergency rooms. M.N.I. Willems & D. J. van de Wijngaart & H. Bergman & A. Adiyaman & D. Telting & F. F. Willems. Neth Heart J. 2014.
  11. HEART score and clinical gestalt have similar diagnostic accuracy for diagnosing ACS in an unselected population of patients with chest pain presenting in the ED. Anniek Visser, Albert Wolthuis, Rob Breedveld, Ewoud ter Avest. Emerg Med J Published Online First. doi:10.1136/emermed-2014-203798.

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