Figure 2

The Decision Aid. The decision aid describes for patients the rationale for, and results of, the initial emergency department evaluation (electrocardiogram, initial cardiac troponin level) and the potential utility of additional cardiac testing. A reliable estimate of the risk of an acute coronary syndrome within 45 days, obtained from a quantitative pretest probability (QPTP) web-tool developed and tested by Kline et al. [5, 15, 16], is included. The decision aid will be individualized to the patient based on the results of the QPTP risk calculator. The risk estimate is displayed using a state-of-the-art risk communication pictograph using an ordered icon array displaying natural frequencies, and a prose description of patient risk (for example, out of every 100 patients with factors like yours, 1 had a heart attack or pre-heart attack diagnosis within 45 days, 99 did not) to account for differences in numeracy preferences between patients. The decision aid also provides explicit management options (admission with urgent cardiac stress testing, follow-up with a cardiologist or the patient’s own primary care physician within 24 to 72 hours, or have the clinician make the decision on the patient’s behalf) for the clinician and patient to consider when reaching a shared decision.