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Strongly favor this test or intervention.

The INTERCHEST clinical prediction rule is a tool designed to evaluate the risk of coronary artery disease (CAD) in patients who present with chest pain in a primary care scenario. This assessment is achieved by reviewing a set of six distinct factors, each asking for a simple yes or no answer, which ultimately calculates a score indicating the likelihood of CAD.

These are the factors considered in the INTERCHEST rule:

- Is the patient male and aged 55 years or older, or female and aged 65 years or older?
- Does the patient have a history of coronary artery disease?
- Did the physician initially suspect a serious condition based on the patient's presentation?
- Does the chest discomfort feel like pressure to the patient?
- Is the chest pain related to physical effort or exertion?
- Can the pain be reproduced when the physician applies physical palpation?

Each affirmative answer to these questions adds one point to the total score, while a negative answer adds no points. Thus, the total score ranges from 0 to 6.

The interpretation of the INTERCHEST score helps guide clinical decision-making:

- A score of 1 or below indicates a low risk of coronary artery disease. This is related to an estimated CAD prevalence of about 2.1%.
- A score of 2 or above suggests a high risk, implying an estimated CAD prevalence of 43.0%.

This scoring system helps healthcare providers stratify risk and decide further management steps for patients with chest pain, ensuring that those who might need more intensive investigation or immediate intervention are identified promptly.

The INTERCHEST clinical prediction rule is a diagnostic tool used in primary care settings to evaluate patients presenting with chest pain. The name "INTERCHEST" is an abbreviation derived from the study "International Chest pain prediction rule" which developed this tool. 

This calculator is specifically designed for adult patients who present to primary care with chest pain. Its primary clinical utility is to help clinicians estimate the probability of coronary artery disease (CAD) in these patients. By considering various patient characteristics and symptoms, the INTERCHEST rule provides a score that can predict the likelihood of CAD, thereby aiding in decision-making about further diagnostic testing and management.

The INTERCHEST rule should not be used in patients with known CAD, those with a clear alternative diagnosis for their chest pain, or those with chest pain due to trauma. It is also not intended for use in emergency settings, where more acute causes of chest pain (such as myocardial infarction) need to be ruled out.

INTERCHEST clinical prediction rule for chest pain in primary care

The HEART score is an assessment tool for evaluating the risk of major adverse cardiac events based on five factors: age, risk factors, patient history, electrocardiogram results, and troponin levels. Each of these factors is assigned a score from 0 to 2, contributing to a total HEART score ranging from 0 to 10. This score helps clinicians determine a patient's risk level for cardiac events.

The scoring breakdown is as follows:

Age:
- ≥ 65 years: 2
- 45-65 years: 1
- < 45 years: 0

Risk Factors:
- ≥ 3 risk factors or a history of atherosclerotic disease: 2
- 1-2 risk factors: 1
- No known risk factors: 0

History:
- Highly suspicious: 2
- Moderately suspicious: 1
- Slightly suspicious: 0

Electrocardiogram:
- Significant ST depression: 2
- Nonspecific repolarization disturbance: 1
- Normal: 0

Troponin:
- > 2× normal limit: 2
- 1-2× normal limit: 1
- ≤ normal limit: 0

By evaluating each category and summing the scores, the total HEART score is calculated, which leads to a specific risk interpretation:

Low Score (0-3): Indicates a low risk of major adverse cardiac events, with the probability ranging from 0.9% to 1.7%.

Moderate Score (4-6): Suggests a moderate risk, where the likelihood of major events falls between 12% and 16.6%.

High Score (7-10): Denotes a high risk, with estimated risks significantly increasing to between 50% and 65%.

These detailed scores help guide clinical decision-making by providing a structured, evidence-based risk assessment.

The HEART Score for Chest Pain is a clinical calculator used in the evaluation of patients presenting with chest pain in the emergency department. The acronym HEART stands for History, ECG, Age, Risk Factors, and Troponin, which are the five elements used to calculate the score. 

This scoring system is designed to stratify risk in patients with chest pain, helping clinicians to decide whether a patient can be safely discharged, requires further diagnostic testing, or needs immediate intervention. It is particularly useful in identifying patients at low risk of major adverse cardiac events within the next six weeks.

There are no specific exclusion criteria for the use of the HEART Score, but it should be noted that it is not designed to replace clinical judgment. It should be used as a tool to aid decision-making in conjunction with a thorough clinical assessment.

HEART score for chest pain

The Emergency Department Assessment of Chest Pain Score (EDACS) is a tool designed to assess the risk of chest pain in patients by calculating a numerical score based on various clinical inputs. This score helps determine the clinical pathway by indicating the level of risk associated with the patient's chest pain. Here’s a guide to how the EDACS works:

The calculator uses six key inputs, each assigned a set of points based on specific conditions:

- Age (years):
  - 18-45: 2 points
  - 46-50: 4 points
  - 51-55: 6 points
  - 56-60: 8 points
  - 61-65: 10 points
  - 66-70: 12 points
  - 71-75: 14 points
  - 76-80: 16 points
  - 81-85: 18 points
  - >= 86: 20 points

- Gender:
  - Male: 6 points
  - Female: 0 points

- Known coronary artery disease or ≥3 risk factors (only for patients aged 18-50 years):
  - Yes: 4 points
  - No: 0 points

- Symptoms and signs:
  - Diaphoresis: 3 points
  - Chest pain radiating to arm or shoulder: 5 points
  - Chest pain occurring or worsening with inspiration: 4 points
  - Chest pain reproduced by palpation: 6 points

- New ischemia on electrocardiogram:
  - Yes: 16 points
  - No: 0 points

- Troponins (initial and 2-hour):
  - Both negative: 0 points
  - Either positive: 16 points

For each of these inputs, the corresponding points are summed up to give a total score. This cumulative score ranges from a minimum of 5 to a maximum of 68.

Next, interpret the score:

- Scores less than 16 suggest a low risk: "Safe for discharge to early outpatient follow-up (or proceed to earlier inpatient testing)."
- Scores of 16 or higher indicate the patient is not at low risk: "Not eligible for discharge, proceed with usual care with further observation and troponin testing."

This interpretation helps healthcare providers decide on the appropriate management strategy, ensuring that patients with higher risk receive adequate observation and testing, while those deemed low-risk can be safely discharged or directed to follow-up care.

The Emergency Department Assessment of Chest Pain Score (EDACS) is a clinical calculator used in the emergency department setting to stratify the risk of patients presenting with chest pain. It is specifically designed to identify patients at low risk of major adverse cardiac events (MACE) within 30 days, who are safe for early discharge without further diagnostic testing. 

The EDACS applies to adult patients presenting to the emergency department with symptoms suggestive of acute coronary syndrome. It incorporates variables such as age, sex, risk factors for coronary artery disease, duration of pain, pain characteristics, and initial ECG changes to generate a score. 

The clinical utility of the EDACS is to aid in the safe and efficient disposition of patients in the emergency department, reducing unnecessary admissions and investigations, and improving patient flow. 

Exclusion criteria for the use of EDACS include patients with obvious non-cardiac causes of chest pain, known coronary artery disease, or those who are hemodynamically unstable.

Emergency Department Assessment of Chest Pain Score (EDACS)

The calculator categorizes the severity of heart failure using the New York Heart Association (NYHA) functional classification system. It does this by analyzing a patient's reported physical abilities related to cardiac disease and matches them to one of the four NYHA classes.

Here's the breakdown of each class:

- Class I involves patients who have cardiac disease but do not experience any limitations in physical activity. Regular activities do not cause undue fatigue, palpitation, or shortness of breath.
  
- Class II fits patients who have a slight limitation in physical activity due to cardiac disease. They feel comfortable when at rest, but ordinary physical activities might lead to fatigue, palpitation, or breathlessness.
  
- Class III describes patients with a marked limitation in physical activity. These individuals are comfortable when resting, but even less than ordinary activities cause fatigue, palpitations, breathlessness, or chest pain.
  
- Class IV covers patients who cannot engage in any physical activity without experiencing discomfort. They exhibit symptoms of heart failure even when at rest, and any physical activity worsens these symptoms.

To determine the appropriate class for a patient, the calculator compares the user’s description of their physical ability with these four established patterns. Each condition is linked specifically to one of the NYHA classes, providing a clear pathway from symptom description to classification. For example, if a patient’s physical condition matches the criteria for Class I, then the result is "Class I." This comparison method efficiently identifies the level of heart failure severity based on self-reported abilities and symptoms.

The NYHA functional classification for heart failure, or New York Heart Association Functional Classification, is a scoring system used to quantify the severity of symptoms in patients with heart failure. This classification system is applicable to patients diagnosed with heart failure and is used to assess their functional capacity and limitations during physical activity. 

The NYHA classification is divided into four classes: Class I (no symptoms and no limitation in ordinary physical activity), Class II (mild symptoms and slight limitation during ordinary activity), Class III (marked limitation in activity due to symptoms, even during less-than-ordinary activity), and Class IV (severe limitations, experiences symptoms even while at rest).

The clinical utility of this calculator is to guide treatment decisions, assess prognosis, and evaluate the effectiveness of therapeutic interventions in patients with heart failure. It is also commonly used in clinical trials to stratify patients and measure outcomes. 

There are no specific exclusion criteria for its use, but it is subjective and relies on patient self-report, so it may not be as accurate in patients with cognitive impairment or communication difficulties.

Chest pain

Guidelines

Key sources