TOPLINE

In adults attended by emergency medical services (EMS) for chest pain, a conveyance strategy guided by the PreHEART score was noninferior to usual care for unexpected serious adverse events, with more patients not recommended for transport to the hospital.

METHODOLOGY

• The PreHEART score combines a history of symptoms, findings of ECG, age, sex-specific cardiovascular risk, and point-of-care troponin I. Researchers in Netherlands conducted a randomized, open-label trial to assess whether EMS conveyance guided by the PreHEART score was noninferior to usual care in adults with chest pain.
• A total of 5170 adults (mean age, 64.4 years; 49.6% women) who were attended by EMS for chest pain between March 2021 and April 2022 were randomly assigned to undergo conveyance guided by either the PreHEART score or usual care.
• Patients who scored 0-3 on PreHEART were recommended for no transport to the hospital with a physician follow-up, those who scored 4-7 were recommended for transport to the nearest emergency department, and those who scored 8-10 were recommended for direct transport to a percutaneous coronary intervention center.
• The primary endpoint was a composite of unexpected serious adverse events at 3 days, ranked by clinical priority. A win ratio above 1 favored PreHEART, and noninferiority required the lower bound of the 95% CI to exceed 0.80.
• Secondary endpoints included rates of nonconveyance, diagnosis of acute coronary syndrome, 30-day healthcare costs, and mortality at 30 days, 6 months, and 12 months.

TAKEAWAY

• Conveyance guided by the PreHEART score was noninferior to usual care for 3‑day unexpected serious adverse events (win ratio, 1.01; 95% CI, 0.89-1.16; P < .001), and this finding persisted through 12 months.
• Patients in the PreHEART group were 41% more likely than those in the usual care group not to be transported to the hospital at first contact (P < .001).
• Mortality was similar between groups, and no patient who was not transported died within 3 days in either group. Patients in the PreHEART group were 12% less likely to present to an emergency department within 30 days (P < .001), and had lower 30-day healthcare costs (mean difference, -€345; P = .001).
• In an exploratory subgroup analysis, women in the PreHEART group were 48% more likely to be diagnosed with acute coronary syndrome and 66% more likely to undergo coronary angiography than those in the usual care group (P < .05 for both).

IN PRACTICE

"Applied to an estimated 150,000 EMS chest-pain contacts per year in the Netherlands, the €345 mean per-patient saving corresponds to roughly €52 million annually and optimising thresholds could increase this further," the researchers wrote.

SOURCE

The study was led by Dennis C. Sagel, University Medical Center Groningen, Groningen, Netherlands. It was published online on September 29 in Heart.

LIMITATIONS

About half of patients did not return written consent forms. An analysis limited to patients who completed the score and received the assigned care did not show noninferiority. The study was restricted to a Dutch EMS system with strong infrastructure.

DISCLOSURES

The authors did not declare a specific funding source or any competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.