What are the American College of Cardiology (ACC) criteria for chest pain accreditation?

From the Guidelines

The American College of Cardiology (ACC) criteria for chest pain accreditation prioritize a multidisciplinary approach to care, emphasizing evidence-based protocols, rapid assessment, and seamless coordination between emergency services and cardiac care teams, as outlined in the 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guideline 1.

Key Requirements for Accreditation

• Establishing standardized chest pain protocols that consider chest pain equivalents, such as shortness of breath and fatigue, as recommended in the guideline 1
• Implementing rapid assessment pathways for early identification or exclusion of life-threatening causes, with a focus on high-sensitivity troponins for biomarker diagnosis of acute myocardial infarction 1
• Maintaining 24/7 cardiac catheterization laboratory capabilities with prompt activation times, typically under 30 minutes
• Ensuring seamless coordination between emergency services and cardiac care teams, including pre-hospital care coordination and emergency department assessment
• Demonstrating appropriate risk stratification tools, such as structured risk assessment, to identify patients most likely to benefit from further testing 1
• Timely administration of medications like aspirin, antiplatelet agents, and anticoagulants when indicated, as part of the early care for acute symptoms 1
• Proper use of cardiac biomarkers and non-invasive testing, with a preference for high-sensitivity cardiac troponins 1

Accreditation Process and Quality Improvement

The accreditation process evaluates pre-hospital care coordination, emergency department assessment, inpatient care, and discharge processes, including cardiac rehabilitation referrals and secondary prevention strategies. Ongoing quality improvement initiatives, staff education programs, and community outreach efforts for heart attack awareness are also essential components, as they help ensure consistent, high-quality care for chest pain patients while reducing unnecessary admissions and improving outcomes, in line with the ACC and AHA's mission to improve cardiovascular health 1.

From the Research

American College of Cardiology (ACC) Criteria for Chest Pain Accreditation

The American College of Cardiology (ACC) criteria for chest pain accreditation are not explicitly stated in the provided studies. However, the studies provide information on the management of acute coronary syndrome (ACS) and the guidelines for dual antiplatelet therapy (DAPT).

Guidelines for Dual Antiplatelet Therapy (DAPT)

• The American College of Cardiology/American Heart Association (ACC/AHA) guidelines recommend aspirin plus a P2Y12 inhibitor for at least 12 months for patients with ACS 2.
• The guidelines also recommend the use of aspirin, beta-blockers, unfractionated heparin or low-molecular-weight heparin, or glycoprotein IIb/IIIa inhibitors for patients undergoing catheterization and revascularization 3.
• The choice of P2Y12 inhibitor (clopidogrel, prasugrel, or ticagrelor) depends on the patient's risk of bleeding and other factors 2, 4.

Accreditation and Guideline Adherence

• A study found that hospitals accredited by the Society of Chest Pain Centers (SCPC) had higher adherence to ACC/AHA guidelines for non-ST-segment elevation myocardial infarction (NSTEMI) than non-accredited hospitals 5.
• Another study found that increasing adherence to ACC/AHA guidelines is key to improving outcomes for patients with ACS 3.

Platelet Reactivity and Antiplatelet Therapy

• A study found that prasugrel resulted in more potent inhibition of platelet function compared to clopidogrel and ticagrelor in patients with ACS undergoing percutaneous coronary intervention (PCI) 4.
• The study also found that ticagrelor achieved a consistent antiplatelet effect with reduced rates of high on-treatment platelet reactivity (HPR) and low on-treatment platelet reactivity (LPR) compared to clopidogrel 4.