Cardiology Corner: Clinical Decision Instruments

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Nurses Edition Commentary

Kathy Garvin, RN and Lisa Chavez, RN
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Mike J., M.D. -

I think the direct comparison of TMACS, EDAC and HEART is a bit misleading. They use different testing. T-Macs is predicated on a high sensitivity troponin. EDAC-ADP doesn't say which troponin they used, but excludes patients with ongoing pain.

Highlighting the concepts of knowing how the rule was derived and applied. I.e. how many folks know that the risk factors in HEART include a BMI>30?

Pragmatically, I think HEART, while more subjective in some ways, may be the most well validated and associated with the least risk.

Mike J.

Mary C. -

Similar to above - my ED is not yet using high-sensitivity troponin, so I would assume I would not use the T-MACS until this happens. Is the EDACS based on traditional or high-sensitivity troponin? Sorry if you addressed this and I missed it.

Amal M., M.D. -

TMACS uses hs-TN. I'm not using that since we don't have hs-TN yet.
EDACS used conventional TN.
Agree with you and also Mike's comment, we need to use the studies exactly as they were validated. We primarily use HEART but it's good to have and know about options.

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