PreHEART score for emergency medical services triage of chest pain: a randomised trial
Dennis C Sagel, Pieter J Vlaar, Duolao Wang, Jesse Demandt, Wybe Nieuwland, Roelof Lettinga, Robert van Barneveld, Edward Jorna, Roelof Kijlstra, Carien van Well, Rick Schram, Ijsbrand Klip, Rutger Anthonio, Louis Bartels, Sjoerd Hofma, Youlan Gu, Marcel Gosselink, Dirk Jan Drenth, Antoinette van Asselt, Peter Van der Meer, Erik Lipsic, Luis Eduardo Juarez Orozco, Pim van der HarstBackground
Triage and support in conveyance decision making of patients with undifferentiated chest pain is the next chapter after validation of the PreHEART score. The PreHEART 3 study tests whether a PreHEART score-guided emergency medical services (EMSs) conveyance is non-inferior to usual care with respect to unexpected serious adverse events in adults attended by EMS for undifferentiated chest pain.
Methods
Pragmatic, randomised, open-label, blinded-endpoint non-inferiority trial was conducted in the Netherlands by Emergency Medical Services. 5170 adults attended by EMS for undifferentiated chest pain, randomised 1:1 to a conveyance decision guided by the prehospital PreHEART score versus usual care. Main outcome measures hierarchical composite of unexpected serious adverse events at 3 days, analysed by win ratio (non-inferiority threshold: lower bound of the 95% CI >0.80).
Results
PreHEART-guided care was non-inferior (win ratio 1.01; 95% CI 0.89 to 1.16; p<0.001), with no deaths within 3 days among 1526 non-conveyed patients. It increased non-conveyance (34.6% vs 24.5%), reduced 30-day emergency presentations (risk ratio (RR) 0.88) and lowered costs (−€345). In women, acute coronary syndrome (ACS) diagnosis (RR 1.48) and angiography (RR 1.66) increased; multiplicative interactions were nominally significant but not after Holm correction.
Conclusions
PreHEART-guided EMS conveyance was non-inferior to usual care for serious adverse events, reduced emergency department presentations and costs, and was associated with increased ACS detection and coronary angiography in women.
Trial registration number
NL-OMON27238.