Improving the Accuracy of Referrals of Patients With Chest Pain (URGENT2)
Chest Pain, Acute Coronary Syndrome, Myocardial Infarction
About this trial
This is an interventional diagnostic trial for Chest Pain focused on measuring Modified HEART score, Point-of-care testing, Troponin, Siemens Healthineers
Eligibility Criteria
Inclusion Criteria:
- Age ≥ 18 years.
- Chest pain or other complaints suspect of ACS for at least 2 hours where the GP or emergency medical personnel are in need of further diagnostics or risk stratification to come to a decision of referral.
- Patients, who have been informed of the nature of the study, agree to its provisions and have provided written informed consent.
Exclusion Criteria:
- Electrocardiographic ST-segment elevation/High suspicion of STE-ACS.
- Suspicion of an acute non-coronary diagnosis e.g. pulmonary embolism, thoracic aortic dissection or other life-threatening disease.
- Patients presenting cardiogenic shock, defined as: systolic blood pressure <90mmHg and heart rate >100 and peripheral oxygen saturation <90% (without oxygen administration)
- Patients presenting with sudden onset heart rhythm disorders and second or third degree atrioventricular block.
- Patients with confirmed ACS, PCI or CABG <30 days prior to inclusion.
- Impaired consciousness defined as an EMV <8.
- Severe shortness of breath.
- Patients with known end-stage renal disease (dialysis and/or MDRD < 30 ml/min).
- Patients with known cognitive impairment.
- Communication issues with patient/language barrier.
- Patients already participating in an interventional cardiology or cardiovascular trial.
Sites / Locations
- Laurentius Hospital RoermondRecruiting
- Viecuri Medical Centre Northern LimburgRecruiting
Arms of the Study
Arm 1
Arm 2
Experimental
Active Comparator
Intervention group
Control group
Chest pain patients in the intervention group will be assessed by EMT personnel by performing the modified HEART score (including POC high sensitive troponin-I measurement (POC HS cTnI)) and the referral policy depends on the result. In case of a low modified HEART score (modified HEART 0-3) patients will not be referred to the cardiac ED. Patients with a modified HEART score >3 are directly referred to the cardiac ED after evaluation. These patients will receive standard care.
Chest pain patients in the control group will receive standard triage and standard care according to the local (EMT) protocol.