Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Apr 16, 2025
Date Accepted: Jan 14, 2026
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Computerized Self-Reported Medical History-Taking Improves Early Rule-Out of Major Adverse Cardiac Events in Acute Chest Pain Patients: The CLEOS-CPDS Prospective Cohort Study
ABSTRACT
Background:
Self-reported, computerized history-taking (CHT) may provide efficient and automated collection of medical histories for calculating risk scores recommended in acute chest pain management.
Objective:
We aimed to determine if risk scores, populated by CHT data, can rule-out a 30-day major adverse cardiac events (MACE), evaluate their diagnostic accuracy, and assess their impact on acute chest pain management.
Methods:
In this prospective cohort study (2017–2019) at a tertiary hospital ED, clinically stable patients aged ≥18 years with chest pain and an ECG not indicating an acute coronary syndrome provided medical histories through a tablet-based CHT program (Clinical Expert Operating System, CLEOS), owned by a public university. The Danderyd History, ECG, Age, Risk factors, and Troponin (D-HEART), HEART, Emergency Department Assessment of Chest Pain Score Accelerated Diagnostic Protocol (EDACS-ADP), and Troponin-only Manchester Acute Coronary Syndrome (T-MACS) scores, were calculated from relevant CHT data and electronic health record (EHR) data, extracted by research staff. EHRs were reviewed for International Classification of Diseases (ICD) codes indicating any 30-day 3-point MACE.
Results:
In the 1,000 participants included (mean age 55±17 years; 46% women), the risk scores could be calculated in 73– 83% using only CHT data, depending on the risk score applied. A 30-day MACE occurred in 7.2% of the total population. The negative predictive value for a 30-day MACE was 0.98–0.99 (95% CI: 0.97–1.00) and a substantial fraction (up to 17%) of patients admitted with acute chest pain could be reclassified from “not low risk” to “low risk” using this method.
Conclusions:
Automated medical history-taking using CHT can offer reliable risk scores in a majority of acute chest pain patients, with high diagnostic accuracy to rule-out a 30-day three-point MACE. This tool could facilitate the management and safe discharge of low-risk patients with acute chest pain in the ED. Clinical Trial: ClinicalTrials.gov NCT03439449. Registration date: 2018-02-13.
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