ADAPT Protocol for Cardiac Event Risk
2-hour accelerated diagnostic protocol (ADAPT) for chest pain: TIMI score, ECG, and troponin I at 0 and 2 hours (contemporary sensitive assays). Identifies low-risk patients suitable for early discharge (1 of 392 low-risk patients, 0.25 %, had a 30-day MACE).
Score interpretation
All 4 ADAPT criteria met — 30-day MACE <1%
→ Discharge with outpatient cardiology or stress test within 72 hours; aspirin 300 mg loading (adults); return precautions documented; shared decision-making; GP notification. Children: use a children's formulary.
At least 1 ADAPT criterion not met — cannot use early discharge pathway
→ Admit for further evaluation; serial troponins at 3 and 6 hours; GRACE score; echocardiography; cardiology review; treat per ACS guidelines if NSTEMI confirmed
Interpretation bands for the ADAPT Protocol. Apply clinical judgement and local guidance.
References
- Than M et al. 2-Hour Accelerated Diagnostic Protocol to Assess Patients With Chest Pain. J Am Coll Cardiol. 2012;59(23):2091-2098.
Related
Curated clinical cross-links plus same-class fallbacks.
- HEART Score for Major Adverse Cardiac Events · Chest Pain
- EDACS — Emergency Department Assessment of Chest Pain · Chest Pain
- HEAR Score for Acute Chest Pain · Chest Pain
- ACTION ICU Score for Intensive Care in NSTEMI · Chest Pain
- Marburg Heart Score · Chest Pain
- INTERCHEST Clinical Prediction Rule · Chest Pain
- Lidocaine IV (Cardiac Arrhythmia) · Antiarrhythmic
- Protamine Sulphate (Heparin Reversal) · Heparin Reversal / Cardiac Surgery
- Mavacamten · Cardiac myosin inhibitor
- Adrenaline (Anaphylaxis Protocol) · Auto-injector / IM adrenaline for anaphylaxis
- Methoxyflurane · Inhaled Analgesic — Acute Pain
- Digoxin · Cardiac Glycoside
- Acute Heart Failure · ESC 2021 Heart Failure Guidelines; NICE NG106
- NSTEMI / Unstable Angina · ESC 2020 NSTEMI Guidelines; NICE NG185
- New-Onset Atrial Fibrillation · ESC 2020 AF Guidelines; NICE NG196
- Hypertensive Emergency · ESC/ESH 2018 Hypertension Guidelines; NICE NG136
- Bradycardia Management · Resuscitation Council UK ABCDE; ESC 2021 Pacing Guidelines
- Ventricular Tachycardia / Fibrillation · Resuscitation Council UK ACLS; ESC 2022 Ventricular Arrhythmia Guidelines
Featured in these MRCEM clinical pathways
The ADAPT Protocol is covered in detail — with RCEM/NICE evidence base, indications and pitfalls — in the following exam-focused pathways on our sister siteReviseMRCEM.
MRCEM Primary / Intermediate / OSCE candidates: each pathway includes exam-style questions, RCEM/NICE citations, and FAQ summaries.
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.