Key result
Pre-hospital POC troponin rule-out for suspected NSTE-ACS cuts 30-day costs ~€611 vs direct ED transfer.
Why the study?
Patients with suspected NSTE-ACS are routinely transferred to the ED, but whether a pre-hospital rule-out strategy using point-of-care troponin could safely identify low-risk patients and reduce healthcare costs was unknown.
Does a pre-hospital rule-out strategy using POC troponin measurement reduce healthcare costs in low-risk suspected NSTE-ACS patients?
Population
863 suspected NSTE-ACS patients with HEAR score ≤3 across five ambulance regions in the Netherlands
Comparison
Pre-hospital rule-out with POC troponin measurement vs direct transfer to the ED
Design
Investigator-initiated randomized clinical trial
Follow-up
30 days
Authors
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May warrant pre-hospital POC troponin rule-out in low-risk NSTE-ACS; extends randomized evidence on safe early discharge.
RCT (n=863)
randomized
Yes
Does a pre-hospital rule-out strategy using POC troponin measurement reduce healthcare costs in low-risk suspected NSTE-ACS patients?
Effect estimate: Mean difference €611 (95% CI 353-869)
Absolute Event Rate: 1349% vs 1960%
p-value: p=<0.001
A pre-hospital rule-out strategy using POC troponin in low-risk suspected NSTE-ACS patients significantly reduces healthcare costs without compromising safety.
Camaro et al. (2023) conducted an RCT in Suspected non-ST-segment elevation acute coronary syndrome (NSTE-ACS) (n=863). Pre-hospital rule-out with point-of-care (POC) troponin measurement vs. Direct transfer to the emergency department (ED) was evaluated on 30-day healthcare costs (Mean difference €611, 95% CI 353-869, p=<0.001). Pre-hospital rule-out of suspected NSTE-ACS using POC troponin significantly reduced 30-day healthcare costs compared to direct ED transfer (mean difference €611; 95% CI 353-869; P<0.001).
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