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Christiaan J M Vrints, Improving outcomes of acute coronary syndromes through better risk stratification, earlier and more accurate diagnosis of acute myocardial infarction and assessment of frailty, European Heart Journal. Acute Cardiovascular Care, Volume 7, Issue 2, 1 March 2018, Pages 99–101, https://doi.org/10.1177/2048872618767743
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The great majority of patients presenting to the emergency department with recent onset chest pain without ST segment elevation do not have an acute coronary syndrome (ACS).1,2 Therefore, it is important to have diagnostic algorithms and risk stratification tools that allow accurate and quick diagnosis of an ACS but also identification of very low risk chest pain patients that safely can be discharged without hospitalisation. As more than one third of the patients with recent onset chest pain have a very low risk of major adverse cardiac events it would very useful to have risk stratification tools that allow to identify these patients before transportation to the hospital is considered. The HEART score that is based on the patients’ history, ECG changes, age, cardiovascular risk factors and a measurement of cardiac troponin has been developed to risk stratify undifferentiated chest pain patients in the emergency department. In a first study of the FamouS Triage project the feasibility of using a modified HEART score at the patient’s home, incorporating only a single highly sensitive troponin T (hs cTn T) measurement was assessed.3 Although false negative hs cTn T test results were observed in almost one in three patients the study shows that the use of a modified HEART score allows to reliably identify chest pain patients with a low probability of having an ACS what may lead to a reduction of overcrowding at the emergency department, healthcare costs and unnecessary patient anxiety.
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