What criteria should I use to determine whether to refer a patient with suspected ACS to secondary care?

Refer people to hospital as an emergency if they currently have chest pain or if they are pain free but had chest pain in the last 12 hours and a resting 12‑lead ECG is abnormal or not available ¹.

Refer people for assessment in hospital if the pain has resolved and there are signs of complications such as pulmonary oedema, using clinical judgement to decide whether the referral should be as an emergency or urgent same-day assessment ¹.

Carry out a detailed clinical assessment, confirm the diagnosis by resting 12‑lead ECG and blood troponin level, and use clinical judgement to decide whether referral is necessary and how urgent it should be, especially if the last episode of chest pain was more than 72 hours ago and no complications are present ¹.