The Clinical Utility of Scoring Systems Such as TIMI Risk Score and Heart Score for Patients >65 Years Old

As the world’s population continues to age and life expectancy increases for both men and women in industrialized countries, medical care and healthcare spending for the elderly will continue to grow. Unfortunately, the field of geriatric medicine, and geriatric cardiology specifically, has been slow to develop. Except for atrial fibrillation studies, most large population-based studies and randomized clinical trials continue to be conducted with little focus on older patients (>65 years old) and the consideration for further age stratification to better identify patients at increased risk for cardiac events. Increasingly, hospital systems and emergency departments are implementing scoring systems, such as TIMI and HEART, to help risk stratify patients presenting with chest pain to appropriately triage these patients. We present a review of the current literature regarding TIMI and Heart score, with a specific focus on older patients, > 65 years old. We provide evidence for the need to consider further age stratifications for both the TIMI risk score and Heart score in this older age group. As a demographic, patients over the age of 65 continue increase in number and in turn, represent a larger proportion of patients presenting with chest pain to emergency departments throughout Europe and the US. Future studies should focus on the clinical utility of existing scoring systems in older patients to more appropriately risk stratify these patients, helping to answer the question of whether risk increases linearly with increasing age and whether a 65 yo should be treated differently than a 75 or 85yo?