Heart (British Cardiac Society) · 2026
PreHEART score for emergency medical services triage of chest pain: a randomised trial.
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Sagel Dennis C, Vlaar Pieter J, Wang Duolao, Demandt Jesse, Nieuwland Wybe, Lettinga Roelof, van Barneveld Robert, Jorna Edward, Kijlstra Roelof, van Well Carien, Schram Rick, Klip Ijsbrand, Anthonio Rutger, Bartels Louis, Hofma Sjoerd, Gu Youlan, Gosselink Marcel, Drenth Dirk Jan, van Asselt Antoinette, Van der Meer Peter, Lipsic Erik, Juarez Orozco Luis Eduardo, van der Harst Pim
Аннотация
BACKGROUND: 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.
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.