🧭 REBEL Rundown
📌 Key Points
- 🧠 Millions present with chest pain yearly—HEART and EDACS identify low-risk patients to reduce unnecessary admits.
- 📊 Both HEART and EDACS have strong negative predictive value for 30-day MACE when paired with high-sensitivity troponin.
- 🫀 HEART Score is simpler—based on History, EKG, Age, Risk factors, and Troponin—and designed specifically for chest pain.
- 📚 EDACS is broader—captures symptoms suspicious for ACS, not just chest pain, and performs well in low-risk patients.
- 💡 Bottom line: Both are safe and validated. Use the tool that fits your patient’s presentation and your departmental workflow.
- 👉 Click here to access the HEART Score on MDCalc
- 👉 Click here to access the EDACS Score on MDCalc
🤕 Case
A 55 year old woman with a history of hypertension and diabetes presents with chest pain for two hours. She describes it as a dull, burning and pressure-like pain in the middle of her chest that does not radiate. She denies any associated symptoms. She is well-appearing with a normal cardiac, pulmonary, abdominal, extremity, and neurologic exam. Her EKG is normal sinus rhythm without ischemic changes. After receiving Aspirin, Pepcid and Maalox, she states, “my husband made me come here, and my pain is completely gone… Can I go home now?”
🔨 Why Do We Need a Clinical Decision Rule?
- Between 6-9 million patients present to the ED for chest pain annually.
- Objectively risk-stratifying these patients may help guide management and optimize resource utilization, resulting in shorter hospital and ED stays for low risk patients, and earlier interventions for moderate- and high-risk patients.
🎯 Quick Hits
💬 Case Resolution
You explain to your patient that based on her history, risk factors, and physical exam, you recommend keeping her in the department for serial cardiac enzyme testing. She had two negative troponins at 0 and 3 hours, remained symptom-free, and has an appointment scheduled with her cardiologist tomorrow.
🚨 Clinical Bottom Line
Both HEART and EDACS are best utilized for identifying patients with suspected ACS who are at low risk for MACE. HEART Score is specifically designed for patients presenting with chest pain, whereas EDACS can be applied to a broader patient population with various symptoms suspicious for ACS, including those with chest pain. Both HEART Pathway and EDACS-ADP can be applied using high-sensitivity troponin, resulting in a decreased number of low risk patients and rate of MACE.
Post Peer Reviewed By: Marco Propersi, DO (Twitter/X: @Marco_Propersi), and Mark Ramzy, DO (X: @MRamzyDO)
🧭 Cheat Sheets
- Created June 30, 2025
- Cardiovascular
- DOWNLOAD
- Created June 30, 2025
- Cardiovascular
- DOWNLOAD
👤 Author
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