Abstract
In the majority of patients with chest pain, an acute coronary syndrome (ACS) can be ruled out. However, early recognition of an ACS is required in order to start treatment as soon as possible and reduce risks associated with myocardial ischaemia. Because of the lack of pre-hospital protocols to rule out an ACS, patients with a suspected ACS are transported to the emergency department, where the HEART score can be used to estimate the risk of major adverse cardiac events (MACE). Patients with a low HEART score have a low risk of MACE. A point-of-care (POC) troponin measurement enables ambulance paramedics to calculate the HEART score in the pre-hospital setting. POC troponin measurement and HEART score assessment have several potential advantages, including early recognition of an ACS and identification of high-risk patients before hospital arrival. Moreover, pre-hospital rule-out of an ACS could prevent unnecessary emergency department visits. The safety and cost-effectiveness of referring low-risk patients with a normal POC troponin value to the general practitioner are currently being investigated in the ARTICA randomised trial. This point-of-view article demonstrates one of the potential advantages of early detection of an ACS.
Highlights
A 49-year-old man called the emergency services because of chest pain that had been present for 10 h
Because of the lack of prehospital protocols to rule out an acute coronary syndrome (ACS), high numbers of patients are transported to the emergency department (ED) when an ACS is suspected, even when the a priori risk for an ACS is low
To estimate the risk for major adverse cardiac events (MACE) in chest pain patients presenting to the ED, the HEART score can be used
Summary
In patients with chest pain, one of the main diagnostic concerns is whether the pain is due to an ACS. To estimate the risk for major adverse cardiac events (MACE) in chest pain patients presenting to the ED, the HEART (history, electrocardiogram, age, risk factors and troponin) score can be used. This score was designed to identify patients eligible for early discharge from the ED [4]. Ruling out an ACS at home with the HEART score and a POC troponin measurement could prevent unnecessary ED visits and subsequently reduce healthcare consumption and costs. The safety and cost-effectiveness of referring low-risk patients with a normal POC troponin T value (
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More From: Netherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation
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