Use of the GRACE score by cardiology nurse specialists in the emergency department

Suspected cardiac chest pain is responsible for a significant number of emergency department attendances and 999 calls to ambulance ser vices in the UK. Differentiating patients with acute coronary syndrome (ACS) is a major diagnostic challenge. The GRACE risk prediction tool provides a validated method of calculating the risk of in-hospital death, 6-month death and myocardial infarction. This study aimed to determine whether systematic application of the GRACE risk-score by cardiology nurse specialists predicts long-term outcome in unselected patients with chest pain. Seven-thousand patients had a GRACE score recorded between September 2005 and April 2008. A random sample of 504 patients was extracted and their outcomes analysed. Incidence of death by April 2009 was recorded, with a follow-up period ranging from 31 to 44 months. Median length of hospital stay, confirmation of ACS and cardiac catheterization on index admission were recorded. There were significant differences in confirmation of ACS, lengt...