The preHEART model is a risk assessment tool that can be used by ambulance nurses to more accurately estimate the risk of coronary artery disease.
When a patient calls the emergency number or the general practitioner for issues resembling myocardial infarction symptoms, the emergency room will send an ambulance. The ambulance team examines the patient and determines whether there is a myocardial infarction. There is a wide variety of possible symptoms that can accompany a myocardial infarction. The Dutch Heart Foundation has published more information (link) about recognizing a myocardial infarction. Approximately 50% of myocardial infarctions can be detected with an electrocardiogram (ECG), which is a video of the heart.
The ambulance team will make an ECG to determine whether the patient is experiencing a myocardial infarction. If a myocardial infarction is visible on the ECG, the patient will receive blood thinners and is transported to a specialized hospital for further treatment. Only 9% of patients with suspected myocardial infarctions have a myocardial infarction that can be detected with an ECG.
Why is a risk assessment required?
Every year, Dutch ambulance services transport approximately 100,000 patients with chest pain to a hospital to rule out a myocardial infarction.Research suggests that a large proportion of these patients have no heart disease (40--60%) whilst only a smaller proportion (5--15%) did indeed have a) myocardial infarction. Currently, most patients with chest pain are transported to the nearest hospital, leading to needless delays in myocardial infarction treatment as well as longer waiting times and needless first aid hospitalization. By using a risk assessment tool, the ambulance care provider can provide a more accommodating treatment for the patient. By combining medical history (H), ECG (E), age (A), risk by gender (R), and troponin values in blood samples (T), the preHEART score is determined, and the patient is classified in a low, medium, or high risk group.
The preHEART score
The preHEART score calculates the myocardial infarction risk within a few days after symptoms emerge. This risk score comprises of five elements. Besides the pattern of medical complaints, the ECG, gender and age of the patient, the troponin blood value is also used. Troponin is a marker that is only detectable in the blood when the heart is injured, as is the case during a myocardial infarction. The score indicates whether a suspected patient is at low, medium, or high risk of having a myocardial infarction. The preHEART score has been scientifically researched and is very reliable.
What do the researchers expect?
We hypothesize that the introduction of the preHEART model will lead to better and more efficient medical care for everybody in the Netherlands who calls the emergency number for chest pain. With this study, we can determine whether introducing the preHEART risk model will lead to better and more efficient care. If this is the case, then we will use the preHEART risk model across the country and perhaps in all of Europe.
What are the implications for patients?
In this study, half of patients will receive standard treatment, and the other half will receive standard treatment while using the preHEART risk assessment. Randomisation to the groups is determined by the number assigned to the ambulance by the emergency room. In both groups, patients will receive a questionnaire and be asked for permission to use the collected data for further analysis. Follow-up questionnaires will follow 1 month, 6 months, and 12 months after first contact with the ambulance.