Abstract / Description of output
Chest pain suspicious for myocardial infarction is a common reason for ambulance transfer to hospital where the HEART score may be used to identify those at low risk and potentially suitable for early discharge.1 The HEART score combines the history, electrocardiogram, age, risk factors, and cardiac troponin with each component allocated 0, 1, or 2 points and scores of ≤3, 4–6, and ≥7 considered low, intermediate, and high risk, respectively.1 Data pertaining to the HEAR components of the score are routinely collected by paramedics in the prehospital setting.2, 3 Recent studies suggest paramedics may be able to use the HEART score to manage some low-risk patients without direct hospital transfer.4, 5 This is attractive, with intuitive benefits for patients, ambulance services, and emergency departments (EDs).
However, prospective studies of the reliability of the HEART score between different grades of clinicians have demonstrated variable results in hospital,6, 7 as have two studies that have involved paramedics.8, 9 A better understanding of the factors that influence risk assessment in the prehospital setting is necessary to ensure robust decision making and comparable safety to rule-out myocardial infarction as in the ED.10
In this prospective study we compare agreement between the HEART score and its components when performed by paramedics in the prehospital setting and clinicians at first assessment in hospital. This prespecified analysis of the Ambulance Cardiac Chest Pain Evaluation in Scotland Study (ACCESS)2 was approved by the National Ethics Committee (REC/14/NS/1037). Consenting adult patients with chest pain suspicious for a myocardial infarction without persistent ST-segment elevation on the prehospital electrocardiogram had a HEAR score recorded by a study trained paramedic using their own interpretation of the history and electrocardiogram who also obtained a venous blood sample that was conveyed with the patient for testing with the Abbott ARCHITECTSTAT high-sensitivity troponin I assay (sex-specific 99th centile 16 ng/L in women and 34 ng/L in men).
However, prospective studies of the reliability of the HEART score between different grades of clinicians have demonstrated variable results in hospital,6, 7 as have two studies that have involved paramedics.8, 9 A better understanding of the factors that influence risk assessment in the prehospital setting is necessary to ensure robust decision making and comparable safety to rule-out myocardial infarction as in the ED.10
In this prospective study we compare agreement between the HEART score and its components when performed by paramedics in the prehospital setting and clinicians at first assessment in hospital. This prespecified analysis of the Ambulance Cardiac Chest Pain Evaluation in Scotland Study (ACCESS)2 was approved by the National Ethics Committee (REC/14/NS/1037). Consenting adult patients with chest pain suspicious for a myocardial infarction without persistent ST-segment elevation on the prehospital electrocardiogram had a HEAR score recorded by a study trained paramedic using their own interpretation of the history and electrocardiogram who also obtained a venous blood sample that was conveyed with the patient for testing with the Abbott ARCHITECTSTAT high-sensitivity troponin I assay (sex-specific 99th centile 16 ng/L in women and 34 ng/L in men).
Original language | English |
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Journal | Academic Emergency Medicine: A Global Journal of Emergency Care (AEM) |
Early online date | 23 May 2024 |
DOIs | |
Publication status | E-pub ahead of print - 23 May 2024 |