New GRACE Calculator for Acute Coronary Syndrome

Latest and Greatest: Overview 2015 American Heart Association Emergency Cardiovascular Care Updates

Cardiovascular disease ranks as one of the leading causes of death around the world. Acute Coronary Syndrome (ACS) is a group of cardiovascular conditions that develop when there is decreased blood flow to the coronary arteries which supply the myocardium, thus the heart muscle is unable to function properly and dies.

According to the American Heart Association, ACS is an absolute emergency. The symptoms of acute coronary syndrome include chest discomfort and pain, pain in both arms which radiate to the neck or jaw, shortness of breath, dizziness, sweating, and nausea. These symptoms, together with other parameters such as cardiac biomarkers, risk factors, and other laboratory and diagnostic workups can be utilized for prompt diagnosis and management. Thus, healthcare providers must be capable of recognizing patients with acute coronary syndrome immediately since delays can cause failure of treatment. Another fundamental process for the appropriate management of ACS is risk stratification most especially among patients who do not seem to have high risk features yet eventually diagnosed to have ACS and Coronary Artery Disease.

GRACE is one risk stratification scoring developed for short- and longer-term risk assessment. GRACE stands for Global Registry of Acute Coronary Events. It was born out of a 10-year research program and multinational study of Acute Coronary Syndrome in more than 100,000 patients in 30 countries. The study aimed to address the lack of consistency in patient management and outcome because clinical trials had not taken into consideration the full spectrum of patients and the diversity of clinical practice.

The GRACE risk score works by predicting the possibility that an individual would experience heart attack and or death based on the following factors: age, heart rate, systolic blood pressure, renal function, congestive heart failure, ST-segment deviation, cardiac arrest, and elevated cardiac biomarkers. While previous parameters cannot define the risk of death and heart attack, the GRACE calculator for acute coronary heart syndrome was able to deduce that survivors of ‘non-ST elevation ACS’ (previously perceived as minor or threatened heart attacks) had high long-term risks of death and recurrent heart attacks.

The GRACE calculator for acute coronary syndrome can be downloaded as a mobile application. Through its user-friendly interface, physicians and other healthcare services providers are guided on how to more effectively manage their patients.

In addition to GRACE risk scoring, the American Heart Association Guidelines recommend that all patients be risk stratified for the selection of an initial management strategy and site of care through Braunwald Risk Stratification and TIMI Risk Score. While stratification can be employed for patient management, they cannot be used to determine as to when the patient can be discharged from the Emergency Department.

 

 

References:          

American Heart Association. Web-based Integrated Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care – Part 9: Acute Coronary Syndromes. ECCguidelines.heart.org.

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“Acute Coronary Syndrome.” American Heart Association, July 2015. Web. <http://www.heart.org/HEARTORG/Conditions/HeartAttack/AboutHeartAttacks/Acute-Coronary-Syndrome_UCM_428752_Article.jsp#.V0-LbJF9600>.

The GRACE Risk Score: Assessing Heart Attack Risk and Guiding Treatment.” N.p., n.d. Web. <http://www.ed.ac.uk/research/impact/medicine-vet-medicine/grace>.