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4%). Physicians referred 157patients (23.6%) and missed 6MACEs. Asimplified HEART score ≥2 would have picked up 5cases, at the expense of 332 referrals (50.0%, p 0.001). AHEART-GP score of ≥3 and ≥4 would have detected 5 and 3MACEs and led to 293 (44.1%, p 0.001) and 186 (28.0%, p = 0.18) referrals, respectively. HEART-score modifications including the physicians' 'sense of alarm' may be used as arisk stratification tool for chest pain in primary care in the absence of routine access to troponin assays. Further validation is
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