Chest Pain Choice

  • Chest pain is the 2nd most common reason patients visit emergency departments across the U.S., accounting for over 8 million visits annually.
  • Physicians frequently admit very low risk patients for prolonged observation and urgent cardiac testing due to concerns about missed diagnosis.
  • The Chest Pain Choice (CPC) decision aid provides an estimate of the risk for acute coronary syndrome within 45 days of the ED visit from data readily available from the initial presentation, examination, and laboratory tests.
  • The purpose of the CPC trial was to have patients and clinicians engage in a joint discussion about the decision to stay in the hospital for advanced cardiac testing or to go home and attend arranged follow-up either with cardiology or their own primary care provider in the next 24-72 hours.

Tools:

Risk calculator tools: 3 options

After calculating the risk for acute coronary syndrome, select the corresponding decision aid to be used during the encounter.  When selecting the appropriate decision aid, we recommend selecting the decision aid with the most conservative (i.e. highest) risk estimate. For example, if the HEART score is 0 and the risk is 0.9 to 1.7%, then select the decision aid representing 2% risk.

  • CPC decision aids for practice settings that frequently use coronary CT angiography

Decision Aid 1%                            Decision Aid 6%                               Decision Aid 17%
Decision Aid 2%                            Decision Aid 7%                               Decision Aid 50%
Decision Aid 3%                            Decision Aid 8%
Decision Aid 4%                            Decision Aid 9%
Decision Aid 5%                            Decision Aid 10%

  • CPC Decision aids for practices that do not frequently use or have access to coronary CT angiography

Decision Aid 1%                            Decision Aid 6%                             Decision Aid 15%
Decision Aid 2%                            Decision Aid 7%                             Decision Aid 17%
Decision Aid 3%                            Decision Aid 8%                             Decision Aid 50%
Decision Aid 4%                            Decision Aid 9%
Decision Aid 5%                            Decision Aid 10%

  • CPC decision aids and discussion aids for practices using HEAR(T) Pathway.  High troponin is defined as >99th percentile limit of a normal reference population for your test.  Low troponin is defined as <99th percentile for your test.

Decisions aids are intended to support shared-decision making conversations:

HEAR(T) 0-3%, low troponin            HEAR(T) 0-3%, high troponin
HEAR(T) 4%, low troponin               HEAR(T) 4%,  high troponin

Discussion aids are intended to support conversations with patients having higher or lower risk: 

HEAR(T) 1%, low troponin               HEAR(T) 1%, high troponin 
HEAR(T) 20%, low troponin             HEAR(T) 20%, high troponin
HEAR(T) 50%, low troponin             HEAR(T) 50%,  high troponin

  • CPC Decision aid – EN ESPAÑOL  (coming soon)
  • Online version (coming soon)

Decision aids in practice:

  • Video demonstration of how to use the decision aid
  • Storyboard showing the steps in using the decision aid (coming soon)

Additional resources

DISCLAIMER:  No decision aid replaces the conversation patients should have with their clinicians to make important, clinical decisions.  Use of these decision aids carries no liability to its developers or to the Mayo Clinic Foundation for Education and Research.

Feedback
If you download our decision aids, we would love to hear from you!  Please send us a note at kerunit@mayo.edu to let us know who you are, why you are interested in the decision aid(s), and how you plan to use them.  Remember to check back to this page periodically to make sure you are using the most up-to-date version(s).

Contact Us · Privacy Policy