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The authors’ reply:
  1. D Brieger1,
  2. G Fitzgerald2,
  3. G Steg3,
  4. K Fox4
  1. 1
    Department of Cardiology, Sydney, Australia
  2. 2
    Center for Outcomes Research, University of Massachusetts Medical School, Worcester, USA
  3. 3
    Département de Cardiologie, Université Paris, Paris, France
  4. 4
    Cardiovascular Research, University of Edinburgh, Edinburgh, UK
  1. Correspondence to Dr D Brieger, Department of Cardiology, Concord Hospital Hospital Rd, Concord Sydney, 2139 Australia; davidb{at}

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We thank Dr Lim and Dr Starmer for their letter1 commenting on our article.2

The GRACE risk score was developed to identify the high-risk population and does so very well.3 However, what is clear when approaching this “multifaceted condition called acute coronary syndrome (ACS)”, is that not being at high risk is not the same as being at low risk.4 Our Freedom from Event score makes use of (the absence of) some of the same factors included in the GRACE risk score and combines them with additional clinical features that enables better risk stratification within the non-high-risk population. These patients do make up the majority of ACS presentations and our tool allows the identification of those who can be treated in less resource-intensive environments, or triaged to earlier discharge. In our view, approaches to more efficiently manage these patients are justified, whatever the angle….


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  • Provenance and Peer review Commissioned; not externally peer reviewed.