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Diamond and Forrester Chest Pain Prediction Rule
Aka: Diamond and Forrester Chest Pain Prediction Rule
- See Also
- Chest Pain
- Acute Chest Pain Approach
- Angina Diagnosis
- Cardiac Risk Assessment
- Cardiac Risk Management
- TIMI Risk Score
- Bosner Chest Pain Decision Rule
- Cardiac Risk in Diabetes Score
- Chest Wall Pain Prediction Rule
- Framingham Score
- HEART Score
- GRACE Score
- Vancouver Chest Pain Rule
- Criteria
- Substernal Chest Pain
- Exertional Chest Pain
- Chest Pain relieved with rest
- Interpretation
- Typical Angina: 3 criteria from above
- Age 30-39: 76% likelihood (intermediate) in men and 26% in women (intermediate)
- Age 40-49: 87% likelihood (high) in men and 55% in women (intermediate)
- Age 50-59: 93% likelihood (high) in men and 73% in women (intermediate)
- Age 60-69: 94% likelihood (high) in men and 86% in women (high)
- Atypical Angina: 2 criteria from above
- Age 30-39: 34% likelihood (intermediate) in men and 12% in women (low)
- Age 40-49: 51% likelihood (intermediate) in men and 22% in women (low)
- Age 50-59: 65% likelihood (intermediate) in men and 31% in women (intermediate)
- Age 60-69: 72% likelihood (intermediate) in men and 51% in women (intermediate)
- Non-Anginal Chest Pain: 1 criteria from above
- Age 30-39: 4% likelihood (low) in men and 2% in women (low)
- Age 40-49: 13% likelihood (intermediate) in men and 3% in women (low)
- Age 50-59: 20% likelihood (intermediate) in men and 7% in women (low)
- Age 60-69: 27% likelihood (intermediate) in men and 14% in women (intermediate)
- No criteria present
- Risk is low to very low for both men and women
- Application
- Low risk patient: Avoid stress testing (higher risk of False Positives)
- Intermediate risk patient: Stress Testing
- Exercise Stress Test is first-line for most men and women
- Stress Imaging test if abnormal baseline EKG, prior revascularization, or Diabetes Mellitus
- Pharmacologic Stress Test if unable to Exercise
- High risk patient: Consider coronary angiogram
- References
- Diamond (1979) N Engl J Med 300(24):1350-8 [PubMed]