Reliability of the HEART-score in the prehospital setting using point-of-care troponin

Waarden, Nancy W.P.L. van der; Schotting, Bob; Royaards, Kees‐Jan; Vlachojannis, Georgios J.; Backus, Barbra E.

doi:10.1097/mej.0000000000000930

Cited by 3 publications

(2 citation statements)

References 14 publications

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“…This study is a retrospective analysis of 569 patients included in two prospective, multicenter studies; Study A is a prospective, multicenter study conducted at four regional hospitals and two ambulance services between October 2018 and March 2019 (van Meerten et al, 2021). Study B is a prospective study conducted at two regional hospitals and one ambulance service between March 2018 and February 2019 (van der Waarden et al, 2022). The local Medical Ethics Committee (MEC) approved both studies.…”

Section: Methodsmentioning

confidence: 99%

“…In Study B, all AN calculated a total HEART score including a troponin measurement on a point-of-care (POC) troponin device (Roche Cobas Point of Care troponin, contemporary troponin with a cut-off value of 40 ng/L) (van der Waarden et al, 2022). For calculation of the interrater reliability, the HEART score was retrospectively scored by two EP, blinded for the HEART score and troponin measurement of the AN.…”

Section: Heart Scorementioning

confidence: 99%

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Assessment of the Diagnostic Accuracy and Reliability of the HEART Score Calculated by Ambulance Nurses Versus Emergency Physicians

van der Waarden,

de Wolf,

van Meerten

et al. 2024

Advanced Emergency Nursing Journal

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Chest pain is a common complaint for consultation of emergency medical services worldwide. Currently, ambulance nurses (AN) base their decision to transport a patient to the hospital on their own professional experience. The HEART score could improve prehospital risk stratification and patient treatment. The aim of this study is to investigate the interrater reliability and predictive accuracy of the HEART score between AN and emergency physicians (EP). A retrospective analysis on data of 569 patients 18 years and older included in two prehospital HEART score studies. The endpoints are interrater reliability (intraclass correlation [ICC]) and predictive accuracy for major adverse cardiac events within 30 days of the HEART score calculated by AN versus EP. Predictive accuracy is sensitivity, specificity, positive predicted value (PPV) and negative predicted value (NPV). Interrater reliability was good for total HEART score (ICC 0.78; 95% CI 0.75–0.81). However, focusing on the decision to transport a patient, the ICC dropped to 0.62 (95% CI 0.62–0.70). History and Risk factors caused the most variability. Predictive accuracy of HEART differed between AN and EP. The HEART score calculated by AN was sensitivity 91%, specificity 38%, PPV 26%, and NPV 95%. The HEART score calculated by EP was sensitivity 98%, specificity 32%, PPV −26%, and NPV 99%. With a cut-off value of 0–2 for a low HEART score, predictive accuracy significantly improved for the HEART score calculated by AN: sensitivity 98%, specificity 18%, PPV 22%, and NPV 98%. Our study shows a moderate interrater reliability and lower predictive accuracy of a HEART score calculated by AN versus EP. AN underestimate the risk of patients with acute chest pain, with the largest discrepancies in the elements History and Risk factors. Reconsidering the cut-off values of the low-risk HEART category, as well as a carefully developed training program, will possibly lead to a higher interrater reliability of the HEART score and higher predictive accuracy used by AN.

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Section: Methodsmentioning

confidence: 99%

Section: Heart Scorementioning

confidence: 99%

Assessment of the Diagnostic Accuracy and Reliability of the HEART Score Calculated by Ambulance Nurses Versus Emergency Physicians

van der Waarden,

de Wolf,

van Meerten

et al. 2024

Advanced Emergency Nursing Journal

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Consequences of Different cut-off Values for high-sensitivity Cardiac Troponin for Risk Stratification of Patients Suspected for NSTE-ACS With a Modified Heart Score

Tolsma,

Fokkert,

Ottervanger

et al. 2023

Future Cardiol.

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Aim: This study aims to enhance prehospital risk assessment for suspected non-ST-elevation acute coronary syndrome (NSTE-ACS) patients using the HEART-score. By incorporating novel point-of-care high-sensitivity cardiac troponin devices, a modified HEART-score was developed and compared with the conventional approach. Patients & methods: Troponin points within the modified HEART-score are based on values below the limit of quantitation (LoQ), between the LoQ and 99th percentile and above the 99th percentile of the used device. A total HEART-score of three or lower is considered low-risk for major adverse cardiac events. Results & conclusion: The number of low-risk patients decreased based on the modified HEART-score. The sensitivity and negative predictive value increased which suggests increasing safety in ruling out patients with suspected NSTE-ACS.

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Management of Patients Suspected for non-ST elevation-acute Coronary Syndrome in the Prehospital Phase

Tolsma,

de Koning,

Fokkert

et al. 2023

Future Cardiol.

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The management of patients with suspected acute coronary syndrome, especially in prehospital settings, is challenging. This Special Report focuses on studies in emergency medical services concerning chest pain patients’ triage and risk stratification. In addition, it emphasizes advancements in point-of-care cardiac troponin testing. These developments are compared with in-hospital guidelines, proposing an initial framework for a new acute care pathway. This pathway integrates a risk stratification tool with high-sensitivity cardiac troponin testing, aiming to deliver optimal care and collaboration within the acute care chain. It has the potential to contribute to a significant reduction in hospital referrals, reduce observation time and overcrowding at emergency departments and hospital admissions.

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Reliability of the HEART-score in the prehospital setting using point-of-care troponin

Cited by 3 publications

References 14 publications

Assessment of the Diagnostic Accuracy and Reliability of the HEART Score Calculated by Ambulance Nurses Versus Emergency Physicians

Assessment of the Diagnostic Accuracy and Reliability of the HEART Score Calculated by Ambulance Nurses Versus Emergency Physicians

Consequences of Different cut-off Values for high-sensitivity Cardiac Troponin for Risk Stratification of Patients Suspected for NSTE-ACS With a Modified Heart Score

Management of Patients Suspected for non-ST elevation-acute Coronary Syndrome in the Prehospital Phase

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