New research led by Mount Sinai Health System indicates that current cardiac screening tools are failing to identify nearly half of individuals at risk for heart attacks. The study, published on November 21, 2023, in the Journal of the American College of Cardiology: Advances, highlights significant limitations in how patient care guidelines are applied, suggesting that reliance on these tools may overlook critical early detection opportunities.
Researchers focused on the commonly used atherosclerotic cardiovascular disease (ASCVD) risk score and a newer assessment method known as PREVENT. These tools are designed to estimate cardiovascular risk based on various factors, including age, sex, blood pressure, and cholesterol levels. According to Amir Ahmadi, MD, the study’s corresponding author and Clinical Associate Professor of Medicine at the Icahn School of Medicine at Mount Sinai, the findings reveal a troubling disconnect.
“Our research shows that population-based risk tools often fail to reflect the true risk for many individual patients,” said Ahmadi. “If we had seen these patients just two days before their heart attack, nearly half would NOT have been recommended for further testing or preventive therapy guided by current risk estimate scores and guidelines.”
The study analyzed data from 474 patients under the age of 66, all of whom experienced their first heart attack at Mount Sinai Morningside and The Mount Sinai Hospital in New York City between January 2020 and July 2025. The assessment included demographic information, medical history, and the timing of symptoms, which were defined as chest pain or shortness of breath.
Doctors typically calculate the ASCVD risk score during annual check-ups for patients aged 40 to 75 who do not have known heart disease. This score estimates a person’s 10-year risk of experiencing a heart attack or stroke. Based on their risk scores, physicians prescribe preventive measures, including statin therapy, to patients with intermediate or high scores. Conversely, those with low or borderline scores are often reassured and sent home without further evaluation.
The study uncovered that if patients who had their first heart attack had been evaluated just two days earlier, 45% of them would have been categorized as low risk and not recommended for preventive therapy according to ASCVD guidelines. This figure increased to 61% when utilizing the PREVENT calculator.
A significant finding was that most patients (60%) did not exhibit symptoms until less than two days prior to their cardiac event, indicating a critical gap in current prevention strategies. The study emphasizes that relying solely on risk scores and symptoms may delay diagnosis until it is too late for effective intervention.
“When we look at heart attacks and trace them backwards, most heart attacks occur in patients in the low or intermediate risk groups,” stated Anna Mueller, MD, the study’s first author and an internal medicine resident at the Icahn School of Medicine. “This study highlights that a lower risk score, along with not having classic heart attack symptoms, is no guarantee of safety on an individual level.”
The researchers advocate for a shift in focus from merely detecting symptomatic heart disease to identifying underlying plaque formation, which could facilitate earlier treatment and potentially save lives.
Looking ahead, the study’s authors stress the need for further research to optimize strategies for early detection and prevention of heart disease, including advancements in cardiovascular imaging. The findings underscore the importance of reevaluating current screening tool effectiveness in guiding individualized patient care and improving health outcomes.
