Stable Chest Pain Guideline Data Standards Developed to Add Uniformity

Newly released data standards for last year’s American College of Cardiology/American Heart Association (ACC/AHA) guidelines for the evaluation and diagnosis of acute or stable chest pain seek to unify the language and definitions used in this space.

The long-awaited multisociety guideline, which debuted in October 2021, promoted a wide variety of modalities to search for underlying CAD with a patient-centered approach.

“The world is a big Tower of Babel with everybody speaking different languages,” writing committee chair H.V. ‘Skip’ Anderson, MD (UT Health Science Center, Houston, TX), told TCTMD. These data standards are “part of the effort of the AHA and the ACC to create a uniform language for these kind of efforts for guidelines, performance measures, [and] registries, trying to get everybody to be on the same page in terms of language so that there's uniform definitions. So that heart attack means the same thing in Miami Beach as it does in Chicago or Denver or anyplace else.”

He explained that this document is really meant as an appendix to the guideline even though it’s being published after the fact. “But the problem is it takes a long time to write the guideline, and when it's finished they want to get it finalized and put out,” Anderson said. “Then the work of actually creating the data standards has to come along. That requires time and effort, so they're never published simultaneously.”

The document, which was published online this week in Circulation: Cardiovascular Quality and Outcomes, broadly groups data elements into the categories of chest pain, myocardial injury, and myocardial infarction.

The authors followed the recommendation of the guideline, which suggested abandoning the terms “typical” and “atypical” and instead using “cardiac,” “possible cardiac,” and “noncardiac” to describe chest pain.

Anderson called this “a big shift,” but said the “clinical community will have to try as much as possible to adopt it. It's always hard to learn new things.”

Overall, “this clinical lexicon and data standard should be broadly applicable in various settings, including patient care, electronic health records (EHRs), quality and performance improvement initiatives, registries, and public reporting programs,” the authors write.

Anderson specified that their goal was to define MI in a way so that it is exactly the same for the ACC/AHA recommendations as it is in all other similar guidelines for atrial fibrillation or heart failure. “So presumably, we're all working from the same set of different definitions, the same dictionary, if you want to think about that way,” he said.