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

Letter to the Editor 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). [...]we read with great interest the correspondence letter by Holmes et al. [...]we believe that a simple adjustment to these components in CACP would be a practical and well-justified approach to optimize risk prediction in this group. [...]it is worth noting that the proposed adjustment of the HEART score remains a proof-of-concept and requires further evaluation in prospective studies.Funding National Heart, Lung, and Blood Institute (R01HL137761, PI: