Improving the Accuracy of Referrals of Patients With Chest Pain

A Multicentre Randomized Controlled Trial to Improve the accUracy of Referrals to the emerGency departmEnt of patieNts With chesT Pain by Using the Modified HEART Score in Emergency Medical Transport (URGENT 2.0)

This is a multicenter, prospective, investigator-initiated, randomized controlled trial aiming to reduce the percentage of non-cardiac chest pain (NCCP) patients admitted to the cardiac emergency department (ED) by performing the modified HEART score by emergency medical transport (EMT) personnel.

Patients with acute coronary syndrome (ACS) should be referred to the hospital promptly. However, referring all patients with chest pain is not feasible, as recent studies showed that up to 80% of the patients with acute chest pain do not have ACS.

Bedside point-of-care (POC) high sensitive troponin testing (in fingerprick blood/capillary blood) and the modified HEART score have become available and might play a substantial role in the triage and diagnosis of chest pain patients in a pre-hospital setting by general practitioners (GPs) and EMT personnel in the future. We hypothesize that patients with chest pain can be referred more accurately by using the modified HEART score.

Inclusion Criteria:

• Age ≥ 18 years.
• Chest pain or other complaints suspect of ACS for at least 2 hours where the GP or emergency medical personnel are in need of further diagnostics or risk stratification to come to a decision of referral.
• Patients, who have been informed of the nature of the study, agree to its provisions and have provided written informed consent.

Exclusion Criteria:

• Electrocardiographic ST-segment elevation/High suspicion of STE-ACS.
• Suspicion of an acute non-coronary diagnosis e.g. pulmonary embolism, thoracic aortic dissection or other life-threatening disease.
• Patients presenting cardiogenic shock, defined as: systolic blood pressure <90mmHg and heart rate >100 and peripheral oxygen saturation <90% (without oxygen administration)
• Patients presenting with sudden onset heart rhythm disorders and second or third degree atrioventricular block.
• Patients with confirmed ACS, PCI or CABG <30 days prior to inclusion.
• Impaired consciousness defined as an EMV <8.
• Severe shortness of breath.
• Patients with known end-stage renal disease (dialysis and/or MDRD < 30 ml/min).
• Patients with known cognitive impairment.
• Communication issues with patient/language barrier.
• Patients already participating in an interventional cardiology or cardiovascular trial.