HEART pathway and Emergency Department Assessment of Chest Pain Score–Accelerated Diagnostic Protocol application in a local emergency department of Hong Kong: An external prospective validation study

Abstract

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.