Nearly Half of Heart Attack Patients Missed by Standard Screening, Mount Sinai Study Finds
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A new study reveals that commonly used cardiac screening methods fail to identify almost half of individuals actually at risk of a heart attack, highlighting a critical gap in preventative care. The findings, released November 21 in the Journal of the American College of Cardiology: Advances, suggest current guidelines may be overlooking those who would benefit most from early intervention.
The Limits of Current Risk Assessments
The research team, led by Mount Sinai investigators, evaluated the accuracy of the atherosclerotic cardiovascular disease (ASCVD) risk score – a widely used tool – and a newer assessment called PREVENT. PREVENT aims to provide a more comprehensive picture of cardiovascular risk by incorporating additional variables alongside symptom screening.
“Our research shows that population-based risk tools often fail to reflect the true risk for many individual patients,” explained a senior researcher involved in the study. “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 underscores a growing concern that relying heavily on traditional risk assessments and reported symptoms may not be the most effective strategy for preventing cardiac events. According to the researchers, a fundamental shift toward identifying silent plaque – early atherosclerosis – before it ruptures may be necessary.
How Risk Scores Guide Preventative Care
Currently, physicians routinely calculate a patient’s ASCVD risk score during primary care visits for adults aged 40 to 75 without known heart disease. This score estimates the 10-year likelihood of a heart attack or stroke, factoring in age, sex, race, blood pressure, cholesterol levels, diabetes, and smoking status. The results then inform decisions about preventative therapies, such as starting statins.
Cardiologists also utilize these scores to guide treatment plans. Patients with intermediate or high scores are typically offered cholesterol-lowering medication and potentially additional diagnostic testing. Conversely, individuals with low or borderline scores, particularly those reporting no symptoms like chest pain or shortness of breath, are often reassured and discharged without further evaluation.
However, the Mount Sinai study revealed a troubling discrepancy: if patients who ultimately experienced a heart attack had been assessed just two days prior, nearly half would have been classified as low or borderline risk by the ASCVD score, and over half would have fallen into that category using PREVENT.
Retrospective Study Reveals Alarming Trends
To assess the performance of these tools, researchers conducted a retrospective review of 474 patients younger than 66 who had experienced their first heart attack between January 2020 and July 2025 at Mount Sinai Morningside or The Mount Sinai Hospital. The team analyzed demographic data, medical history, cholesterol levels, blood pressure readings, and the timing of symptom onset. Each patient’s 10-year ASCVD risk score was calculated, simulating an evaluation conducted two days before their heart attack. Patients were categorized into risk levels: low (under 5 percent), borderline (5-7.5 percent), intermediate (7.5-20 percent), and high (more than 20 percent).
The analysis focused on identifying which patients would have qualified for preventative measures based on their scores and when their symptoms began. The findings were stark: 45 percent of patients would not have been recommended for preventative therapy or further testing under ASCVD-based guidelines. This figure rose to 61 percent when using PREVENT. Furthermore, a significant majority (60 percent) of patients experienced symptoms less than two days before their heart attack, indicating that symptoms often emerge only after the disease has progressed.
A Call for Proactive Detection
“When we look at heart attacks and trace them backwards, most heart attacks occur in patients in the low or intermediate risk groups,” stated the study’s first author, Anna Mueller, MD, an internal medicine resident at the Icahn School of Medicine at Mount Sinai. “This study highlights that a lower risk score, along with not having classic heart attack symptoms like chest pain or shortness of breath, which is common, is no guarantee of safety on an individual level.”
The researchers emphasize that current tools, while effective for tracking large populations, fall short when applied to individualized care. They advocate for a shift in focus from detecting symptomatic heart disease to proactively identifying the underlying plaque buildup. This earlier treatment, they believe, could ultimately save lives.
“Our study exposes a major flaw where tools effective for tracking large populations fall short when guiding individualized care,” Mueller added. “Instead, doctors should shift their focus from detecting symptomatic heart disease to detecting the plaque itself for earlier treatment.”
The team acknowledges the need for further research to refine these methods and explore improved early identification and prevention strategies, including the expanded use of cardiovascular imaging. . This research underscores the urgent need to re-evaluate current preventative practices and prioritize the early detection of silent atherosclerosis to reduce the incidence of heart attacks.
