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EDACS vs. HEART – But Why?

The world has been obsessed over the past few years with the novelty of clinical decision rules for the early discharge of chest pain. After several years of battering the repurposed Thrombolysis in Myocardial Infarction (TIMI) score, History, Electrocardiogram, Age, Risk factors and Troponin (HEART) became ascendant, but there are several other candidates out there. One of these is Emergency Department Assessment of Chest pain Score (EDACS), which is less well-known, but has reasonable face validity. It does a good job identifying a “low-risk” cohort, but is more complicated than HEART. There is also a simplified version of EDACS that goes ahead and eliminates some of the complicated subtractive…

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Articles of Interest

CALC Corner: HEART Score vs. EDACS

Both scores are helpful in identifying low risk chest pain patients for early discharge. EDACS identified more low risk patients than HEART, but HEART currently has more robust external validation.

Clinical utility of EDACS-ADP in patients admitted with chest pain to an emergency department

Most of these patients were classified by the EDACS-ADP as low risk and suitable for discharge. The 30-day MACE rate of development was significantly low (0.9%) and acceptable in patients grouped as low risk.

EDACS – Accurate for Chest Pain Risk Stratification

EDACS is accurate and safe to use in practice for chest pain risk stratification and likely allows more patients to be discharged than the HEART score. Why does this matter? Chest pain risk scores can help us decide which patients to send home vs staying for further workup. The HEART score has a pooled sensitivity of about 96% and specificity 42%. But in a head-to-head comparison, EDACS and T-MAC were superior to HEART. Also, EDACS is easy to score and has clear, non-subjective criteria. Now that multiple studies have looked at EDACS, what’s the consensus on its accuracy?

Effect of the Emergency Department Assessment of Chest Pain Score on the Triage Performance in Patients With Chest Pain

In conclusion, the results of the study suggest that EDACS has a good discriminatory capacity for acute cardiovascular events and that its implementation in routine triage may improve triage performance in patients with chest pain.

Emergency Department Assessment of Chest Pain Score (EDACS)

The goal of these rules is to identify a low-risk population of patients who need less testing than other, higher-risk patients. As a rule-out calculator, the EDACS is good at identifying who is relatively safe to go home (highly sensitive), but not good at identifying who does have the disease (not terribly specific).

The Diagnostic Accuracy of the Emergency Department Assessment of Chest Pain (EDACS) Score: A Systematic Review and Meta-analysis

The EDACS score identified greater than 50% of patients with suspected acute coronary syndrome as suitable for discharge after serial troponin sampling during 2 hours. Sensitivity for major adverse cardiac events was relatively high overall and may be acceptable to clinicians.

Resources

EDACS

Identifies chest pain patients with low risk of major adverse cardiac event. This score only applies to patients: (1) ≥18 years old with normal vital signs; (2) Chest pain consistent with ACS; (3) No ongoing chest pain or crescendo angina.