Stratification of low-risk ischemic chest pain: an umbrella review for its integration into advanced nursing practice in the emergency department

Objective: The objective was to conduct an umbrella review examining tools for stratifying patients presenting with chest pain suspected of low-risk NSTEMI in the emergency department. Method: For this umbrella review, systematic reviews matching the inclusion criteria were searched across three databases. Articles underwent a selection process and were assessed for their methodological quality and level of evidence in accordance with the recommendations outlined in the Johanna Briggs Institute Manual for Evidence Synthesis. According to Pieper et al, the degree of overlap between primary studies was calculated. Evidence from eight systematic reviews was then extracted using a standardized tool. Results: The low-risk HEART score with the use of highly sensitive troponin allowed for the safe discharge of more than one-third of patients with a major adverse cardiac event rate of less than 1% (0.8%). This tool also achieved high sensitivity (sensitivity 97% CI [88 ; 99]) and superiority for the mortality and myocardial infarction components. Its negative predictive value was 0.99, making this score an ideal tool for excluding a major adverse cardiac event in the studied population. The characteristics of the EDACs score were also performing well. However, a study of its extrinsic characteristics and an in-depth analysis of clinical heterogeneity would be necessary. Conclusion: This summary emphasizes the safety and diagnostic accuracy of the low-risk HEART score. After ruling out differential diagnoses, stratifying low-risk ischemic chest pain using the HEART score could secure the innovative care model integrating advanced nursing practice in emergency services.