A novel rapid rule-out protocol for acute chest pain using H-FABP point-of-care testing

Abstract

Emergency department (ED) visits have gradually increased throughout recent years, contributing to the widespread problem of ED overcrowding. The purpose of this study was to develop a rapid rule-out strategy for patients with acute chest pain that integrates clinical characteristics and Heart-type fatty acid binding protein (H-FABP) to improve ED patient care. H-FABP point-of-care test results of 130 patients were integrated into a modified HEART score, with a score ≤ 3 points indicating rule-out of acute coronary syndrome (ACS). Diagnostic performance was assessed with comparative analyses between the Ex-ACS protocol, the conventional HEART score, and the European Society of Cardiology (ESC) 0/1-h algorithm. In this study cohort, eight patients (6.2%) were diagnosed with NSTEMI and none were misclassified as rule-out by the novel protocol. The Ex-ACS protocol ruled out ACS in 63 patients (48.4%) with a median time of 16 min, notably faster than the ESC 0/1-h algorithm (123 min). The Ex-ACS protocol demonstrated a sensitivity of 100% and a specificity of 51.6%, surpassing the traditional HEART score which exhibited a sensitivity of 100% and a specificity of 46.3%. The Ex-ACS Protocol offers a promising strategy for rapid ACS exclusion, potentially improving patient flow in EDs.