Emergency Medicine Australasia

Heart Foundation risk classification of chest pain patients only a fair predictor of heart attack, study finds

The Heart Foundation’s risk classification of emergency department patients with chest pain offers only fair prediction of myocardial infarction (heart attack), and this prediction is not sufficient to justify admission to coronary care for all patients classified as high risk using these criteria.

This is the finding of a study by Professor Anne-Maree Kelly, from the Joseph Epstein Centre for Emergency Medicine Research at Western Health in Melbourne.

The study is published in the latest issue of Emergency Medicine Australasia, the journal of the Australasian College for Emergency Medicine.

“The evaluation of chest pain is a growing challenge for EDs, in particular ruling out acute coronary syndrome (ACS) and determining which patients can safely be discharged for further investigation and management in the community with a low risk of adverse cardiac events,” Professor Kelly said.

She studied almost 800 patients with chest pain who presented at a hospital emergency department, finding a high proportion of these patients were classified as high risk by the Heart Foundation risk classification criteria.

“If all patients classified as high risk had been admitted to a ward environment for assessment, as  recommended by the guidelines, there would have been a 21% increase in admission rate (161 patients) without any reduction in deaths, myocardial infarction during follow up, or arrhythmia.

“These data challenge the Heart Foundation classification criteria and their associated recommendations as a useful tool for the ED chest pain patient group.”

With specificity of approximately 50%, the recommendation for coronary care admission for all high-risk patients is hard to justify, she concluded.