The 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. Among 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. The 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.
Prehospital risk stratification in patients with chest pain
D. Sagel, P. Vlaar, R. van Roosmalen, I. Waardenburg, W. Nieuwland, R. Lettinga, R. van Barneveld, E. Jorna, R. Kijlstra, C. van Well, A. Oomen, L. Bartels, R. Anthonio, V. Hagens, S. Hofma, Y. Gu, D. Drenth, R. Addink, T. van Asselt, P. van der Meer, E. Lipsic, L. Orozco and P. van der Harst
Emerg Med J 2021;38(11):814-819.