Referral decisions based on a pre-hospital HEART score in suspected non-ST-elevation acute coronary syndrome: final results of the Famous Triage study. (14th October 2021)

• Record Type: Journal Article
• Authors: Tolsma, R T; Fokkert, M J; Van Dongen, D N; Slingerland, R J; Badings, E; Van Der Sluis, A; Ottervanger, J P; Van 'T Hof, A W J
• Is Part Of: European heart journal. Volume 42(2021)Supplement 1
• Publication Date: 2021-10-14
• Subjects: Prehospital and Emergency Department Care; Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; 616.12005
• DOI: 10.1093/eurheartj/ehab724.1509
• Languages: English
• ISSNs: 0195-668X

Abstract

Abstract: Background: Recent studies show that pre-hospital risk stratification of patients with suspected non-ST-elevation Acute Coronary Syndrome (NSTE-ACS) by ambulance paramedics is feasible. However, it is not investigated whether making referral decisions based on this risk stratification is safe and not associated with an increased risk of Major Adverse Cardiac Events (MACE). The hypothesis of the Famous Triage study is that implementation of referral decisions by ambulance paramedics based on a pre-hospital HEART score (History, ECG, Age, Risk factors and Troponin), is non-inferior to routine management on the occurrence of MACE within 45 days. Methods: Famous Triage phase III is the first study where referral decisions by paramedics are based on a pre-hospital acquired HEART score. In the second phase (before implementation) a pre-hospital HEART score was assessed without consequences for referral decisions. In the third phase low-risk patients (HEART score ≤3) were not transferred to the hospital. Primary endpoint was the comparison of MACE (acute coronary syndrome, revascularization or death by all causes) within 45 days between phase II and III. Results: A total of 1, 236 patients were included, mean age was 63 years, 43% was female, 700 patients were included in the second phase (all referred to the hospital) and 536 in the third phase in which 149 low-risk patients (28%, HEART score ≤3) 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 odds ratio of 45 days MACE in phase III was 0.88 (95% CI 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, is feasible and non-inferior to transferring all patients to the hospital. This pre-hospital triage strategy might improve value based healthcare (equal outcomes at less costs). FUNDunding Acknowledgement: Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Roche Diagnostics, The Netherlands