Why the study?
Conventional chest pain protocols using the TIMI score may not perform well in emergency departments, motivating validation and comparison of newer scores like the HEART pathway and EDACS-ADP in Hong Kong.
Do the HEART pathway and EDACS-ADP accurately predict 30-day major adverse cardiac events in emergency department patients with chest pain?
Do the HEART pathway and EDACS-ADP accurately predict 30-day major adverse cardiac events in emergency department patients with chest pain?
Both the HEART pathway and EDACS-ADP are highly sensitive for ruling out 30-day MACE in ED patients with chest pain, allowing for safe early discharge of over 70% of patients.
Answers are grounded in this paper and cite their sources.
Supports early discharge in low-risk ED chest pain; extends validation of both scores in an Asian cohort but leaves broader adoption open.
Background: The conventional chest pain protocol using thrombolysis in myocardial infarction score as the risk stratifying tool may not perform well in the emergency department in which a mix of low- and high-risk patients are encountered. Newer chest pain scores such as HEART pathway and Emergency Department Assessment of Chest Pain Score–Accelerated Diagnostic Protocol (EDACS-ADP) are found to have high sensitivity with good specificity. Objectives: This study aims to validate and compare two chest pain scores: HEART pathway and EDACS-ADP in the Accident and Emergency Department of a local hospital in Hong Kong. Methods: A prospective cohort study was carried out at the Accident and Emergency Department of Kwong Wah Hospital in Hong Kong from 1 June 2016 to 31 May 2017. Patients ⩾18 years old with chest pain lasting 5 min or more who were observed with chest pain protocol on observation ward were recruited. Results: A total of 238 patients were recruited; 231 eligible patients completed follow-up. There were five patients with major adverse cardiac events in 30 days of follow-up. The sensitivity, specificity, and negative predictive values of HEART pathway and EDACS-ADP were 100%, 74.3%, 100% and 100%, 73.5.0% and 100%, respectively. Both scores had almost the same performance in terms of major adverse cardiac events at 30 days (area under the curve = 0.87). Conclusion: Our study showed both EDACS-ADP (modified) and HEART pathway achieved high sensitivity (~100%) for detecting major adverse cardiac events in 30 days while being able to discharge more than 70% of patients as low risk for early discharge.
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Yang et al. (2018) studied this question.
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