Summary by Paul Bridgman
Louise Cullen et al; Heart, Lung and Circulation
Cullen and colleagues have previously reported that the IMPACT (The Improved Assessment of Chest Pain Trial) protocol can safely and efficiently allow a large proportion of general patients presenting to EDs with chest pain to undergo accelerated assessment for low, intermediate or high risk of an acute coronary syndrome (ACS).1 After risk assessment, and 2-hour serial troponin results, those deemed at low-risk could be safely discharged without further objective assessment.
Now, working with support from local Aboriginal and Torres Strait Islander Health Community-Controlled Health Organisations (ATSICCHOs), Cullen and colleagues have confirmed that the IMPACT pathway can also be safely implemented for patients of Aboriginal and Torres Strait Islander origin.2
In this trial, high and intermediate risk was managed according to the IMPACT pathway, but low-risk patients had additional cardiac testing in line with the National Heart Foundation/Cardiac Society of Australia and New Zealand 2016 guidelines for the management of ACS.3
Conducted in the Emergency Department of Cairns Hospital, Queensland between November 2017 and December 2019, the trial recruited 155 patients, classified as 11.6% low-risk, 56.1% intermediate-risk and 32.3% high risk for ACS. All patients with ACS were identified on their index admission. None of the patients assessed as low risk of ACS had any evidence of coronary artery disease from objective testing, and none had adverse cardiac events within 30 days of presentation. However, a high burden of cardiovascular risk factors was noted in this cohort.
The research found higher rates of ACS and at a younger age compared with the first IMPACT trial. It also found a high proportion of females with ACS (male, 38.1%). The authors state these findings should not only inform clinicians but also direct public health campaigns to better target those at risk.
1. Med J Aust 2017; 207 (5): 195-200.
2. Heart Lung Circ 2022; DOI: https://doi.org/10.1016/j.hlc.2022.02.010
3. Heart Lung Circ 2016; 25:895-951.