Effectiveness of EDACS Versus ADAPT Accelerated Diagnostic Pathways for Chest Pain: A Pragmatic Randomized Controlled Trial Embedded Within Practice

Effectiveness of EDACS Versus ADAPT Accelerated Diagnostic Pathways for Chest Pain: A Pragmatic Randomized Controlled Trial Embedded Within Practice. Than, M. P., Pickering, J. W., Aldous, S. J., Cullen, L., Frampton, C. M., Peacock, W. F., Jaffe, A. S., Goodacre, S. W., Richards, A. M., Ardagh, M. W., Deely, J. M., Florkowski, C. M., George, P., Hamilton, G. J., Jardine, D. L., Troughton, R. W., van Wyk, P., Young, J. M., Bannister, L., & Lord, S. J. Annals of Emergency Medicine, 68(1):93–102.e1, July, 2016.

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Methods: This was a pragmatic randomized controlled trial of adults with suspected acute myocardial infarction, comparing the ADAPT-ADP and the EDACS-ADP. The primary outcome was the proportion of patients discharged to outpatient care within 6 hours of attendance, without subsequent major adverse cardiac event within 30 days. Results: Five hundred ﬁfty-eight patients were recruited, 279 in each arm. Sixty-six patients (11.8%) had a major adverse cardiac event within 30 days (ADAPT-ADP 29; EDACS-ADP 37); 11.1% more patients (95% conﬁdence interval 2.8% to 19.4%) were identiﬁed as low risk in EDACS-ADP (41.6%) than in ADAPT-ADP (30.5%). No low-risk patients had a major adverse cardiac event within 30 days (0.0% [0.0% to 1.9%]). There was no difference in the primary outcome of proportion discharged within 6 hours (EDACS-ADP 32.3%; ADAPT-ADP 34.4%; difference À2.1% [À10.3% to 6.0%], P¼.65). Conclusion: There was no difference in the proportion of patients discharged early despite more patients being classiﬁed as low risk by the EDACS-ADP than the ADAPT-ADP. Both accelerated diagnostic pathways are effective strategies for chest pain assessment and resulted in an increased rate of early discharges compared with previously reported rates. [Ann Emerg Med. 2016;68:93-102.]

@article{than_effectiveness_2016,
	title = {Effectiveness of {EDACS} {Versus} {ADAPT} {Accelerated} {Diagnostic} {Pathways} for {Chest} {Pain}: {A} {Pragmatic} {Randomized} {Controlled} {Trial} {Embedded} {Within} {Practice}},
	volume = {68},
	issn = {01960644},
	shorttitle = {Effectiveness of {EDACS} {Versus} {ADAPT} {Accelerated} {Diagnostic} {Pathways} for {Chest} {Pain}},
	url = {http://linkinghub.elsevier.com/retrieve/pii/S0196064416000020},
	doi = {10.1016/j.annemergmed.2016.01.001},
	abstract = {Methods: This was a pragmatic randomized controlled trial of adults with suspected acute myocardial infarction, comparing the ADAPT-ADP and the EDACS-ADP. The primary outcome was the proportion of patients discharged to outpatient care within 6 hours of attendance, without subsequent major adverse cardiac event within 30 days.
Results: Five hundred ﬁfty-eight patients were recruited, 279 in each arm. Sixty-six patients (11.8\%) had a major adverse cardiac event within 30 days (ADAPT-ADP 29; EDACS-ADP 37); 11.1\% more patients (95\% conﬁdence interval 2.8\% to 19.4\%) were identiﬁed as low risk in EDACS-ADP (41.6\%) than in ADAPT-ADP (30.5\%). No low-risk patients had a major adverse cardiac event within 30 days (0.0\% [0.0\% to 1.9\%]). There was no difference in the primary outcome of proportion discharged within 6 hours (EDACS-ADP 32.3\%; ADAPT-ADP 34.4\%; difference À2.1\% [À10.3\% to 6.0\%], P¼.65).
Conclusion: There was no difference in the proportion of patients discharged early despite more patients being classiﬁed as low risk by the EDACS-ADP than the ADAPT-ADP. Both accelerated diagnostic pathways are effective strategies for chest pain assessment and resulted in an increased rate of early discharges compared with previously reported rates. [Ann Emerg Med. 2016;68:93-102.]},
	language = {en},
	number = {1},
	urldate = {2018-03-17TZ},
	journal = {Annals of Emergency Medicine},
	author = {Than, Martin P. and Pickering, John W. and Aldous, Sally J. and Cullen, Louise and Frampton, Christopher M.A. and Peacock, W. Frank and Jaffe, Allan S. and Goodacre, Steve W. and Richards, A. Mark and Ardagh, Michael W. and Deely, Joanne M. and Florkowski, Chris M. and George, Peter and Hamilton, Gregory J. and Jardine, David L. and Troughton, Richard W. and van Wyk, Pieter and Young, Joanna M. and Bannister, Laura and Lord, Sally J.},
	month = jul,
	year = {2016},
	keywords = {\_tablet},
	pages = {93--102.e1}
}

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J."],"year":2016,"bibtype":"article","biburl":"https://bibbase.org/zotero/Rory.miller","bibdata":{"bibtype":"article","type":"article","title":"Effectiveness of EDACS Versus ADAPT Accelerated Diagnostic Pathways for Chest Pain: A Pragmatic Randomized Controlled Trial Embedded Within Practice","volume":"68","issn":"01960644","shorttitle":"Effectiveness of EDACS Versus ADAPT Accelerated Diagnostic Pathways for Chest Pain","url":"http://linkinghub.elsevier.com/retrieve/pii/S0196064416000020","doi":"10.1016/j.annemergmed.2016.01.001","abstract":"Methods: This was a pragmatic randomized controlled trial of adults with suspected acute myocardial infarction, comparing the ADAPT-ADP and the EDACS-ADP. The primary outcome was the proportion of patients discharged to outpatient care within 6 hours of attendance, without subsequent major adverse cardiac event within 30 days. Results: Five hundred ﬁfty-eight patients were recruited, 279 in each arm. Sixty-six patients (11.8%) had a major adverse cardiac event within 30 days (ADAPT-ADP 29; EDACS-ADP 37); 11.1% more patients (95% conﬁdence interval 2.8% to 19.4%) were identiﬁed as low risk in EDACS-ADP (41.6%) than in ADAPT-ADP (30.5%). No low-risk patients had a major adverse cardiac event within 30 days (0.0% [0.0% to 1.9%]). There was no difference in the primary outcome of proportion discharged within 6 hours (EDACS-ADP 32.3%; ADAPT-ADP 34.4%; difference À2.1% [À10.3% to 6.0%], P¼.65). Conclusion: There was no difference in the proportion of patients discharged early despite more patients being classiﬁed as low risk by the EDACS-ADP than the ADAPT-ADP. Both accelerated diagnostic pathways are effective strategies for chest pain assessment and resulted in an increased rate of early discharges compared with previously reported rates. 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The primary outcome was the proportion of patients discharged to outpatient care within 6 hours of attendance, without subsequent major adverse cardiac event within 30 days.\nResults: Five hundred ﬁfty-eight patients were recruited, 279 in each arm. Sixty-six patients (11.8\\%) had a major adverse cardiac event within 30 days (ADAPT-ADP 29; EDACS-ADP 37); 11.1\\% more patients (95\\% conﬁdence interval 2.8\\% to 19.4\\%) were identiﬁed as low risk in EDACS-ADP (41.6\\%) than in ADAPT-ADP (30.5\\%). No low-risk patients had a major adverse cardiac event within 30 days (0.0\\% [0.0\\% to 1.9\\%]). There was no difference in the primary outcome of proportion discharged within 6 hours (EDACS-ADP 32.3\\%; ADAPT-ADP 34.4\\%; difference À2.1\\% [À10.3\\% to 6.0\\%], P¼.65).\nConclusion: There was no difference in the proportion of patients discharged early despite more patients being classiﬁed as low risk by the EDACS-ADP than the ADAPT-ADP. 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