Chest Pain Advanced Diagnostic Protocol “ADP”

What is it?  The ADP is simply a pathway that can be used to help standardize the care of patients with chest pain  Using this ADP, the hope is that we can reduce admissions for patients at low risk for Major Adverse Cardiac Events (MACE)  MACE is basically any Acute Coronory Syndrome  Many groups are adopting these, and have shown decreased admission rates without increase in MACE

What does cardiology think?  This pathway has been shared with cardiologists from both groups in Moore County  They have both given us verbal support for this endeavor  Both groups have also pledged to help us get outpatient stress tests for discharged patients in a timely fashion  Remember, ACC guidelines recommend stress testing be done within 72 hours of discharge in low risk patients

OK so what do we do?  The most popular, accurate protocol currently involves using the HEART score as your predictor of risk  This is an easy scoring system to use with data that is readily available to us in the ED.  It uses a single troponin, ekg, and some other risk factors to give you a score.  Any score 3 or less is considered low risk and the patient can be sent home.

Where is this HEART score found?  The easiest way to use this is to go to mdcalc and use their website.  heart - score -for-major-cardiac-events/ heart - score -for-major-cardiac-events/  You can also just search for HEART score online, and usually the mdcalc site is the first result

So what is the risk to the patient?  If HEART score is 3 or less, there is a 1.7% chance of MACE over the next 6 weeks.  I tell patients this.  If you repeat another troponin (3 hours after the first) or if the patient has had constant pain > 6 hours, that risk goes down to just under 1%

What about follow up?  Dr. Martin has arranged for both cardiology groups to help us in scheduling outpatient stress tests.  The forms are located in the file cabinet near the charge nurse desk at MRH.  Patients should be referred to the appropriate group based on their existing cardiology or PCP relationship.  See next page

That’s it!  Recent prospective validation was published showing zero adverse events in their study population using this score  This included a large number of patients that did not show up for their outpatient stress tests  In other words, there is no need to sweat if they show up or not, low risk is low risk  If you have any questions, please see me or Geoff  We would like everyone to start using this ASAP in an effort help decrease unnecessary admissions