• Dennis Sagel, Pieter Jan Vlaar, Radboud van Roosmalen, Ingmar Waardenburg, Wybe Nieuwland, Roelof Lettinga, Robert van Barneveld, Edward Jorna, Roelof Kijlstra, Carien van Well, Antoon Oomen, Louis Bartels, Rutger Anthonio, Vincent Hagens, Sjoerd Hofma, Youlan Gu, Derk Drenth, Ryanne Addink, Thea van Asselt, Peter van der Meer, Eric Lipsic, Luis Juarez Orozco, and Pim van der Harst.
• Expirimental Cardiology, University Medical Center Groningen, Groningen, The Netherlands d.c.sagel@umcg.nl.
• Emerg Med J. 2021 Nov 1; 38 (11): 814-819.

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.© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.

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