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Tolsma RT, Fokkert MJ, van Dongen DN, et al. Referral decisions based on a pre-hospital HEART score in suspected non-ST-elevation acute coronary syndrome: final results of the FamouS Triage study. Eur Heart J Acute Cardiovasc Care. 2021;doi: 10.1093/ehjacc/zuab109.
Tolsma, R. T., Fokkert, M. J., van Dongen, D. N., Badings, E. A., van der Sluis, A., Slingerland, R. J., van 't Riet, E., Ottervanger, J. P., & van 't Hof, A. W. J. (2021). Referral decisions based on a pre-hospital HEART score in suspected non-ST-elevation acute coronary syndrome: final results of the FamouS Triage study. European heart journal. Acute cardiovascular care, . https://doi.org/10.1093/ehjacc/zuab109
Tolsma, Rudolf T, et al. "Referral decisions based on a pre-hospital HEART score in suspected non-ST-elevation acute coronary syndrome: final results of the FamouS Triage study." European heart journal. Acute cardiovascular care vol. (2021). doi: https://doi.org/10.1093/ehjacc/zuab109
Tolsma RT, Fokkert MJ, van Dongen DN, Badings EA, van der Sluis A, Slingerland RJ, van 't Riet E, Ottervanger JP, van 't Hof AWJ. Referral decisions based on a pre-hospital HEART score in suspected non-ST-elevation acute coronary syndrome: final results of the FamouS Triage study. Eur Heart J Acute Cardiovasc Care. 2021 Nov 25; doi: 10.1093/ehjacc/zuab109. Epub 2021 Nov 25. PMID: 34849660.
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Eur Heart J Acute Cardiovasc Care. 2021 Nov 25; doi: 10.1093/ehjacc/zuab109. Epub 2021 Nov 25.

Referral decisions based on a pre-hospital HEART score in suspected non-ST-elevation acute coronary syndrome: final results of the FamouS Triage study.

European heart journal. Acute cardiovascular care

Rudolf T Tolsma, Marion J Fokkert, Dominique N van Dongen, Erik A Badings, Aize van der Sluis, Robbert J Slingerland, Esther van 't Riet, Jan Paul Ottervanger, Arnoud W J van 't Hof

Affiliations

  1. Emergency Medical Service, Ambulance IJsselland, Voltastraat 3A, 8013 PM Zwolle, The Netherlands.
  2. Department of Clinical Chemistry, Isala Hospital, Dokter van Heesweg 2, 8025 AB Zwolle, The Netherlands.
  3. Department of Cardiology, Isala Hospital, Dokter van Heesweg 2, 8025 AB Zwolle, The Netherlands.
  4. Department of Cardiology, Deventer Hospital, Nico Bolkesteinlaan 75, 7416 SE Deventer, The Netherlands.
  5. Department of Research, UMCU, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
  6. Department of Cardiology, MUMC, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.
  7. Department of Cardiology, Zuyderland MC, Henri Dunantstraat 5, 6419 PC Heerlen, The Netherlands.

PMID: 34849660 DOI: 10.1093/ehjacc/zuab109

Abstract

AIMS: Although pre-hospital risk stratification of patients with suspected non-ST-elevation acute coronary syndrome (NSTE-ACS) by ambulance paramedics is feasible, it has not been investigated in daily practice whether referral decisions based on this risk stratification is safe and does not increase major adverse cardiac events (MACE). In Phase III of the FamouS Triage study, it was investigated whether referral decisions by ambulance paramedics based on a pre-hospital HEART score, is non-inferior to routine management.

METHODS AND RESULTS: FamouS Triage Phase III is a non-inferiority study, comparing the occurrence of MACE before (Phase II) and after (Phase III) implementation of referral decisions based on a pre-hospital HEART score. In Phase II, all patients were risk-stratified and referred to the hospital; in Phase III, low-risk patients (HEART score ≤ 3) were not referred. Primary endpoint was MACE (acute coronary syndrome, revascularization, or death) within 45 days. A total of 1236 patients were included. Mean age was 63 years, 43% were female, 700 patients were included in the second phase and 536 in the third phase in which 149 low-risk patients (28%) were not transferred to the hospital. Occurrence of 45 days MACE was 16.6% in Phase II and 15.7% in Phase III (P = 0.67). Percentage MACE in low-risk patients was 2.9% in Phase II and 1.3% in Phase III. After adjustments for differences in baseline variables, the hazard ratio of 45 days MACE in Phase III was 0.88 (95% confidence interval 0.63-1.25) as compared to Phase II.

CONCLUSION: Pre-hospital risk stratification of patients with suspected NSTE-ACS, avoiding hospitalization of a substantial number of low-risk patients, seems feasible and non-inferior to transferring all patients to the hospital.

© The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology.

Keywords: Acute-Coronary-Syndrome; HEART score; Pre-hospital; Triage

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