What does this research mean for the field?

Pre-hospital and in-hospital HEART scores show only moderate agreement, and a 4.7% 30-day MACE rate in pre-hospital low-risk patients indicates that current pre-hospital assessments require improved training and the use of high-sensitivity assays. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This study evaluates the effectiveness of the HEART score in pre-hospital settings for suspected acute coronary syndrome.

April 15, 2026Open Access

Performance of the HEART Score in pre-hospital settings for suspected non-ST-elevation acute coronary syndrome: The POPular HEART Study

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Suspected non-ST-elevation acute coronary syndrome (NSTE-ACS) (n=331). Intervention: Pre-hospital HEART score with point-of-care conventional troponin I vs. In-hospital HEART score with ESC 0/1-hour high-sensitivity troponin T algorithm. Primary outcome: Sensitivity for major adverse cardiac events (MACE) at 30 days (AUC 0.72, 95% CI 0.64-0.81, p=<0.001).

Resultado clave

Pre-hospital HEART score assessment classified 26% of suspected NSTE-ACS patients as low risk, but yielded a 30-day MACE rate of 4.7%, exceeding the 2% safety threshold for early discharge.

Puntos clave

This study evaluates the effectiveness of the HEART score in pre-hospital settings for suspected acute coronary syndrome.
Assessed HEART scores in pre- and in-hospital environments.
Evaluated the 30-day major adverse cardiovascular events (MACE) rate.
Analyzed the agreement of HEART scores across settings.
The 30-day MACE rate was 4.7% in the pre-hospital low-risk group.
Moderate agreement between pre- and in-hospital HEART scores was observed.

Diseño del estudio

Tipo

Observational (n=331)

Enmascaramiento

Single-blind

Multicéntrico

Sí

PICO estructurado

Does the pre-hospital HEART score accurately identify low-risk patients with suspected non-ST-elevation acute coronary syndrome compared to in-hospital assessment?

Población

Patients with suspected non-ST-elevation acute coronary syndrome in pre-hospital settings

Intervención

HEART Score assessment in pre-hospital settings

Comparador

HEART Score assessment in in-hospital settings

Resultado

Agreement between pre- and in-hospital HEART scores and 30-day MACE ratecomposite

The pre-hospital HEART score showed moderate agreement with in-hospital scores, but a 4.7% 30-day MACE rate in the low-risk group suggests the need for improved training and high-sensitivity assays before it can be safely used to rule out ACS pre-hospital.

Resultado numérico

Estimación del efecto: AUC 0.72 (95% CI 0.64-0.81)

Tasa de eventos absoluta: 91.7% vs 100%

valor p: p=<0.001

Limitaciones

Intended sample size of 650 was not reached due to limited availability of the point-of-care conventional cTnI device.
The COVID-19 pandemic disrupted patient enrolment for 6-12 months.
Technical problems affected the completeness of the data.
The study was terminated early due to the reduced relevance of the POC conventional cTnI assay as high-sensitivity assays became available.

Resumen

Pre- and in-hospital HEART scores showed moderate agreement. The 30-day MACE rate (4.7%) in the pre-hospital low-risk group indicates that improved training in history and ECG assessment, and use of high-sensitivity assays are required.

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Discussion

Authors

Jaouad Azzahhafi

Interventional Cardiology

Dean R.P.P. Chan Pin Yin

Interventional Cardiology

Mirjam T. Epping

Diakonessenhuis hospital

Journals

Netherlands Heart Journal

Actions

Institutions

University Medical Center Utrecht

Maastricht University Medical Centre

St. Antonius Ziekenhuis

References and Citations

Connected Papers

Building similarity graph...

Analyzing shared references across papers

Discussion

Cite this study

Azzahhafi et al. (Mon,) conducted a observational in Suspected non-ST-elevation acute coronary syndrome (NSTE-ACS) (n=331). Pre-hospital HEART score with point-of-care conventional troponin I vs. In-hospital HEART score with ESC 0/1-hour high-sensitivity troponin T algorithm was evaluated on Sensitivity for major adverse cardiac events (MACE) at 30 days (AUC 0.72, 95% CI 0.64-0.81, p=<0.001). Pre-hospital HEART score assessment classified 26% of suspected NSTE-ACS patients as low risk, but yielded a 30-day MACE rate of 4.7%, exceeding the 2% safety threshold for early discharge.

synapsesocial.com/papers/69df2a4be4eeef8a2a6af722 — DOI: https://doi.org/10.1007/s12471-026-02041-x

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Performance of the HEART Score in pre-hospital settings for suspected non-ST-elevation acute coronary syndrome: The POPular HEART Study

Resultado clave

Puntos clave

Diseño del estudio

PICO estructurado

Resultado numérico

Limitaciones

Resumen

Citation Network

Connected Papers

Discussion

Authors

Journals

Actions

Institutions

References and Citations

Citation Network

Connected Papers

Discussion

Cite this study

Also consider

Also consider