Impact of educational level on EDACS performance for chest pain risk stratification

The Emergency Department Assessment of Chest Pain Score (EDACS) is a validated tool for identifying patients at very low risk of major adverse cardiac events (MACE), enabling safe discharge without further testing. EDACS incorporates symptom characteristics such as location, pattern, radiation, association with respiration, and cardiovascular risk factors-information typically based on patient self-report. This study aimed to evaluate whether educational level affects patients' ability to describe symptoms, to evaluate risk refinement between the EDACS and the objectively enhanced EDACS-ADP (Accelerated Diagnostic Pathway) classifications. This prospective, cross-sectional, single-center study included patients presenting to a tertiary emergency department with chest pain. Patients were categorized into 3 groups based on educational level. EDACS and EDACS-ADP were calculated for each patient. Risk reclassification and the influence of educational level were analyzed using McNemar's test and multivariable logistic regression. Of 4151 patients admitted to the emergency department with complaints of chest pain during a one-month period, 177 were included. 62.7% were male; the median age was 61.0 years. Overall, 38.4% (48/125) of patients in the EDACS-ADP high-risk category were initially classified as low-risk by EDACS (P < .001). The reclassification rate was highest in Group 1 (low education) at 42.9%, in Group 2 (38.9%), and Group 3 (33.3%) (P < .001 for all). Multivariable logistic regression identified female gender, coronary arterial disease, and smoking as independent predictors of reclassification. Our findings suggest that EDACS-ADP provides additional objective risk refinement across patients with different educational backgrounds.