PreHEART score for emergency medical services triage of chest pain: a randomised trial.

Authors

Dennis C Sagel, Pieter J Vlaar, Duolao Wang, Jesse Demandt, Wybe Nieuwland, Roelof Lettinga, Robert van Barneveld, Edward Jorna, Roelof Kijlstra, Carien van Well, Rick Schram, Ijsbrand Klip, Rutger Anthonio, Louis Bartels, Sjoerd Hofma, Youlan Gu, Marcel Gosselink, Dirk Jan Drenth, Antoinette van Asselt, Peter Van der Meer, Erik Lipsic, Luis Eduardo Juarez Orozco, Pim van der Harst

Published in

Heart (British Cardiac Society). Sep 29, 2026. Epub Sep 29, 2026.

Abstract

Triage and support in conveyance decision making of patients with undifferentiated chest pain is the next chapter after validation of the PreHEART score. The PreHEART 3 study tests whether a PreHEART score-guided emergency medical services (EMSs) conveyance is non-inferior to usual care with respect to unexpected serious adverse events in adults attended by EMS for undifferentiated chest pain.
Pragmatic, randomised, open-label, blinded-endpoint non-inferiority trial was conducted in the Netherlands by Emergency Medical Services. 5170 adults attended by EMS for undifferentiated chest pain, randomised 1:1 to a conveyance decision guided by the prehospital PreHEART score versus usual care. Main outcome measures hierarchical composite of unexpected serious adverse events at 3 days, analysed by win ratio (non-inferiority threshold: lower bound of the 95% CI >0.80).
PreHEART-guided care was non-inferior (win ratio 1.01; 95% CI 0.89 to 1.16; p<0.001), with no deaths within 3 days among 1526 non-conveyed patients. It increased non-conveyance (34.6% vs 24.5%), reduced 30-day emergency presentations (risk ratio (RR) 0.88) and lowered costs (-€345). In women, acute coronary syndrome (ACS) diagnosis (RR 1.48) and angiography (RR 1.66) increased; multiplicative interactions were nominally significant but not after Holm correction. CONCLUSIONS : PreHEART-guided EMS conveyance was non-inferior to usual care for serious adverse events, reduced emergency department presentations and costs, and was associated with increased ACS detection and coronary angiography in women.
NL-OMON27238.

PMID:
42810856
Bibliographic data and abstract were imported from PubMed on 30 Sep 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.