Can a new "Emergency Department Assessment of Chest-pain Score (EDACS)" reduce hospital admissions and observation for patients presenting with possible heart attack?

In people presenting to the Emergency Department (ED) at Christchurch Hospital with chest pain, can a the use of a new "Emergency Department Assessment of Chest-pain Score (EDACS)" compared to the TIMI score increase the proportion of patients “successfully” discharged home within 6 hours of ED arrival with no Major Adverse Cardiac Event (MACE) during the following 30 days?

Status

Completed

Phases

Unknown

Study type

Interventional

Source

ANZCTR

Registry ID

ACTRN12613000745741

Acronym

EDACS

Enrollment

560

Registered

2013-07-04

Start date

2013-07-01

Completion date

2014-07-30

Last updated

2025-11-03

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

None listed

Brief summary

This research investigates an innovative and worklable change to the medical decision making process for patients presenting the Emergency Departments with chest pain that is possibly due to a heart attack. This randomised trial aims to prove the effectiveness of a new "fast-track" (2-hour) pathway compared with the existing "fast-track" pathway that is used in current standard care. It uses a specially purpose developed Emergency Department Assessment of Chest-pain Score (EDACS) to identify low-risk patients rather than the risk score currently used in clinical practice that was not designed for this purpose. This should double the number of patients that can have a heart attack rules out earlier (up to 10 hours earlier) than is usually possible. The EDACS score (and the safety of it's use) has already been observationally validated in a two centre cohort of >600 patients separate from the patient group in which it was developed. If successful this new pathweay would make a tangible contribution to health care by preventing unnecessary hospital admission and facilitating early discharge home in a large group of patients. This outcome is beneficial to both patients and the health service, by reassuring patients earlier that heart attack has been ruled out and by avoiding unnecessary admission, duplication of staff activities, and reducing pressure upon urgent care services.

Interventions

Participants will be randomised to an initial assessment using either the control or experimental Accelerated Diagnostic Pathways (ADPs). The difference between the ADP's is risk assessment score that is used. This is the modified TIMI score in the control arm and the EDACS score in the experimental arm Control ADP: is described below. Experimental ADP uses EDACS score and ECG and troponin: EDACS score Age Score 18-45 =+2 46-50 =+4 51-55 =+6 56-60 =+8 61-65 =+10 66-70 =+12 71-75 =+14 76-80 =+16 81-85 =+18 86+ =+20 3 Risk factors and 18-50 =+4 3 Risk factors and 51+ =+0 Diaphoresis =+3 Radiates to arm or shoulder =+5 Occurred with inspiration (pleuritic) =-4 Reproduced by palpation =-6 Male sex =+6 1) EDACS score <16 2) normal cardiac troponin (cTn) at 0 and 2 hours after arrival, and 3) no new ischaemic changes on ECGs. If ALL three parameters above are met then the patient is classified as low-risk. Low risk patients will be eligible for early discharge to outpatient investigations after the 2-hour troponin result is available. Non low-risk patients will require further cTn testing after at least 6 hours following first or worst symptoms

Study design

Allocation

Randomised controlled trial

Intervention model

Parallel

Primary purpose

Diagnosis

Masking

Blinded (masking used) (Investigator, Outcomes Assessor)

Eligibility

Sex/Gender

All

Age

18 Years to No maximum

Healthy volunteers

Inclusion criteria

Adults (age 18 years or older) presenting acutely from the community to the Emergency Department (ED) with chest pain suggestive of acute coronary syndrome for whom, the attending clinician(s) intend(s) to perform serial troponin analysis (cTns), to investigate for possible acute myocardial infarction. In accordance with American Heart Association guidelines, possible cardiac symptoms include: the presence of acute chest, epigastric, neck, jaw or arm pain or discomfort or pressure without apparent non-cardiac source.

Exclusion criteria

ST Segment Elevation Myocardial Infarction (STEMI) present on any electrocardiograph (ECG). (These patients are at very high risk and guidelines mandate immediate transfer to cardiology facilities for treatment and/ monitoring) Patients with proven or suspected non-coronary pathology as the cause of chest pain Patients who will require admission regardless of a negative cTn, due to other medical conditions, or need for other investigations Transfers from other departments or hospitals and patients attending with an acute troponin result already known to be raised before arrival. Subjects previously enrolled in this study Anticipated problem with follow-up e.g. resident outside New Zealand Patient (or Legal Representative) unable or unwilling to provide informed consent Patients for whom the researcher does not think that recruitment is appropriate for non-medical reasons (e.g. poor mental status, emotionally vulnerable)

Outcome results