Program of research incorporating six studies to improve the assessment and diagnosis of chest pain.

The aim of this study is to prospectively investigate the accuracy and safety of an accelerated’ chest pain diagnostic pathway (ANZAP rule) in patients presenting with intermediate risk chest pain in an Australian setting.

Grant ID: PROG-2010-004-CULLEN-ACS

Lay Summary

Chest pain is one of the most common Emergency Department (ED) presentations, but establishing a diagnosis of heart-related conditions is challenging and resource-intensive. Difficulties occur for a number of reasons. First, there are no tests available to rapidly identify all individuals who have heart conditions. Second, the symptoms of heart disease are varied and are common across a number of different illnesses. Thus, physicians who are treating patients with potential heart disease have to use a number of signs, symptoms, and tests to determine the likelihood that someone has heart disease. This process can take between 12 and 24 hours.

The researchers have conducted a significant program of research and developed a more rapid approach to diagnosing chest pain. This approach allows physicians to identify the risk of heart disease as early as 2 hours after arrival in the ED using clinical information, and blood tests.

The purpose of this study is to demonstrate that the assessment process for patients presenting acutely to hospital EDs with possible cardiac chest pain is safe and accurate. This study will recruit 1000 patients presenting to the Royal Brisbane and Women’s Hospital with greater than 5 minutes chest pain who are assigned as intermediate risk of acute coronary syndromes (ACS) on initial clinical assessment. These individuals will be treated according to the newly developed protocol and followed-up for 45 days to determine the accuracy of the test in predicting patient outcomes.


The results of this study have the potential to achieve significant cost savings for the health system. The study also has the potential to increase patient safety by reducing time to diagnosis and thus reduce overcrowding in Emergency Departments. This is of great interest currently with the move to a ‘4 hour rule’ for admission/discharge planned by the Federal Government to commence in 2012.

Leveraged Funds

- $127,722 In-Kind Support


Cullen L., Greenslade J.H., Hawkins T., Hammett C., O'Kane S., Ryan K., Parker K., Schluter J., Dalton E., Brown A.F.T., Than M,, Peacock W.F., Jaffe A., O'Rourke P.K., Parsonage W.A., "Improved Assessment of Chest pain Trial (IMPACT): assessing patients with possible acute coronary syndromes", Med J Aust 2017; 207 (5): 195-200


Amount Awarded


Grant Scheme


Principal Investigator:
Prof Louise Cullen

Co Investigators:
Prof Anthony Brown
A/Prof Jaimi Greenslade
Prof Peter O’Rourke
Dr Kevin Chu
Dr Xiang Yu Hou
Dr William Parsonage
A/Prof Nicholas Graves
Dr Martin Than


Collaborating Institutions


  • Brisbane Times (3/9/17)
  • MJA Podcast, Louise Cullen (3/9/17)
  • MJA Podcast, Will Pasonage (3/9/17)
  • CONTACT US +61 7 3720 5700 2/15 Lang Parade Milton Qld 4064