48The pre-hospital HEART score is a strong predictor of MACE in patients with suspected non-STEMI

Tolsma, Rudolf T; Dongen, Dominique N van; Fokkert, Marion J; Ottervanger, Jan Paul; Sluis, Aize van der; Slingerland, R. J.; Hof, Arnoud W van ’t

doi:10.1093/eurheartj/ehx501.48

Cited by 4 publications

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“… 9–13 History, ECG, Age, Risk factors, and Troponin (HEART) score calculation ( Table 1 ), including point-of-care (POC) troponin assessment can be used pre-hospitally by paramedics. 9 , 13–15 It adequately stratifies patients in low-, intermediate-, and high risk for major adverse cardiac events (MACE). 2 , 10 , 16 It has, however, not yet been studied in daily practice whether selected low-risk patients with suspected NSTE-ACS can safely stay at home based on pre-hospital risk assessment, avoiding ED presentation.…”

Section: Introductionmentioning

confidence: 99%

Referral decisions based on a pre-hospital HEART score in suspected non-ST-elevation acute coronary syndrome: final results of the FamouS Triage study

Tolsma¹,

Fokkert

Dongen

et al. 2021

European Heart Journal. Acute Cardiovascular Care

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Aims Although pre-hospital risk stratification of patients with suspected non-ST-elevation acute coronary syndrome (NSTE-ACS) by ambulance paramedics is feasible, it has not been investigated in daily practice whether referral decisions based on this risk stratification is safe and does not increase major adverse cardiac events (MACE). In Phase III of the FamouS Triage study, it was investigated whether referral decisions by ambulance paramedics based on a pre-hospital HEART score, is non-inferior to routine management. Methods and results FamouS Triage Phase III is a non-inferiority study, comparing the occurrence of MACE before (Phase II) and after (Phase III) implementation of referral decisions based on a pre-hospital HEART score. In Phase II, all patients were risk-stratified and referred to the hospital; in Phase III, low-risk patients (HEART score ≤ 3) were not referred. Primary endpoint was MACE (acute coronary syndrome, revascularization, or death) within 45 days. A total of 1236 patients were included. Mean age was 63 years, 43% were female, 700 patients were included in the second phase and 536 in the third phase in which 149 low-risk patients (28%) were not transferred to the hospital. Occurrence of 45 days MACE was 16.6% in Phase II and 15.7% in Phase III (P = 0.67). Percentage MACE in low-risk patients was 2.9% in Phase II and 1.3% in Phase III. After adjustments for differences in baseline variables, the hazard ratio of 45 days MACE in Phase III was 0.88 (95% confidence interval 0.63–1.25) as compared to Phase II. Conclusion Pre-hospital risk stratification of patients with suspected NSTE-ACS, avoiding hospitalization of a substantial number of low-risk patients, seems feasible and non-inferior to transferring all patients to the hospital.

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Section: Introductionmentioning

confidence: 99%

Referral decisions based on a pre-hospital HEART score in suspected non-ST-elevation acute coronary syndrome: final results of the FamouS Triage study

Tolsma¹,

Fokkert

Dongen

et al. 2021

European Heart Journal. Acute Cardiovascular Care

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“…4 7 8 Evidence for the use of this tool in the prehospital setting is lacking, and the reported incidence of 2.9% of major events in the low-risk group makes the HEART Score unsafe to rule out ACS, based on a single troponine measurement. [9][10][11] The present study aimed to evaluate the prehospital performance of the HEART Score in patients evaluated by EMS personnel for chest pain and optimise it for the prehospital setting to conduct future prospective studies on safe (non-) conveyance decisions and management strategies.…”

Section: Original Researchmentioning

confidence: 99%

Prehospital risk stratification in patients with chest pain

Sagel

Vlaar

Roosmalen³

et al. 2021

Emerg Med J

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ObjectivesThe History, ECG, Age, Risk Factors and Troponin (HEART) Score is a decision support tool applied by physicians in the emergency department developed to risk stratify low-risk patients presenting with chest pain. We assessed the potential value of this tool in prehospital setting, when applied by emergency medical services (EMS), and derived and validated a tool adapted to the prehospital setting in order to determine if it could assist with decisions regarding conveyance to a hospital.MethodsIn 2017, EMS personnel prospectively determined the HEART Score, including point-of-care (POC) troponin measurements, in patients presenting with chest pain, in the north of the Netherlands. The primary endpoint was a major adverse cardiac event (MACE), consisting of acute myocardial infarction or death, within 3 days. The components of the HEART Score were evaluated for their discriminatory value, cut-offs were calibrated for the prehospital setting and sex was substituted for cardiac risk factors to develop a prehospital HEART (preHEART) Score. This score was validated in an independent prospective cohort of 435 patients in 2018.ResultsAmong 1208 patients prospectively recruited in the first cohort, 123 patients (10.2%) developed a MACE. The HEART Score had a negative predictive value (NPV) of 98.4% (96.4–99.3), a positive predictive value (PPV) of 35.5% (31.8–39.3) and an area under the receiver operating characteristic curve (AUC) of 0.81 (0.78–0.85). The preHEART Score had an NPV of 99.3% (98.1–99.8), a PPV of 49.4% (42.0–56.9) and an AUC of 0.85 (0.82–0.88), outperforming the HEART Score or POC troponin measurements on their own. Similar results were found in a validation cohort.ConclusionsThe HEART Score can be used in the prehospital setting to assist with conveyance decisions and choice of hospitals; however, the preHEART Score outperforms both the HEART Score and single POC troponin measurements when applied by EMS personnel in the prehospital setting.

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Value of Prehospital Troponin Assessment in Suspected Non-ST-Elevation Acute Coronary Syndrome

Dongen

Fokkert

Tolsma

et al. 2018

The American Journal of Cardiology

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48The pre-hospital HEART score is a strong predictor of MACE in patients with suspected non-STEMI

Cited by 4 publications

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Referral decisions based on a pre-hospital HEART score in suspected non-ST-elevation acute coronary syndrome: final results of the FamouS Triage study

Referral decisions based on a pre-hospital HEART score in suspected non-ST-elevation acute coronary syndrome: final results of the FamouS Triage study

Prehospital risk stratification in patients with chest pain

Value of Prehospital Troponin Assessment in Suspected Non-ST-Elevation Acute Coronary Syndrome

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