Key result
PreHEART-guided EMS conveyance is non-inferior to usual care for 3-day serious adverse events.
Why the study?
Triage and support in conveyance decision making for patients with undifferentiated chest pain after validation of the PreHEART score required evaluation in clinical practice.
Does a conveyance decision guided by the prehospital PreHEART score prevent unexpected serious adverse events compared to usual care in adults attended by EMS for undifferentiated chest pain?
RCT (n=5,170)
Open-label, blinded-endpoint
1:1
Does a conveyance decision guided by the prehospital PreHEART score prevent unexpected serious adverse events compared to usual care in adults attended by EMS for undifferentiated chest pain?
PreHEART score-guided EMS triage for undifferentiated chest pain safely increases non-conveyance rates and reduces costs without increasing unexpected serious adverse events compared to usual care.
Supports PreHEART-guided triage to safely raise non-conveyance and cut costs in undifferentiated chest pain; confirms non-inferiority in a large pragmatic RCT.
Background 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. Methods 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). Results 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. Trial registration number NL-OMON27238.
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Sagel et al. (2026) conducted an RCT in Undifferentiated chest pain (n=5,170). PreHEART score-guided conveyance decision vs. Usual care was evaluated on Hierarchical composite of unexpected serious adverse events at 3 days (Win ratio 1.01, 95% CI 0.89-1.16, p=<0.001 for non-inferiority). PreHEART score-guided EMS conveyance was non-inferior to usual care for unexpected serious adverse events at 3 days (win ratio 1.01; 95% CI 0.89-1.16; p<0.001 for non-inferiority).
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