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).

Key Result

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.

Key Points

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.

Study Design

Type

Observational (n=331)

Blinding

Single-blind

Multicenter

Yes

Structured PICO

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

Population

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

Intervention

HEART Score assessment in pre-hospital settings

Comparator

HEART Score assessment in in-hospital settings

Outcome

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.

Main Result

Effect estimate: AUC 0.72 (95% CI 0.64-0.81)

Absolute Event Rate: 91.7% vs 100%

p-value: p=<0.001

Limitations

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.

Abstract

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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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 https://doi.org/https://doi.org/10.1007/s12471-026-02041-x

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