Emergency department visits for chest pain could drop by roughly a third when ambulance crews combine a high-sensitive point-of-care troponin blood test with the HEART-score during pre-hospital triage, according to a study presented at the European Emergency Medicine Congress by researchers in The Netherlands.
Medical teams across emergency systems face a persistent logistical challenge. About 95% of patients experiencing chest pain are transported by ambulance directly to emergency departments for extensive evaluation, yet only a small minority ultimately turn out to have a serious cardiac condition (Mirage News). That routine influx strains hospital resources and exposes patients to crowded emergency environments (News Medical).
Pre-Hospital Testing and the HEART-Score Protocol
A study conducted by the Rotterdam-Rijnmond ambulance service in The Netherlands examined 1,022 patients presenting with acute chest pain between 2022 and 2025 (Mirage News). The investigation evaluated whether moving diagnostic tools directly into the ambulance can safely reduce unnecessary hospital transports (News Medical).
During the initial baseline phase involving 539 patients, ambulance personnel provided standard care by assessing patients on scene and deciding whether transport to an emergency department was necessary (Mirage News). In the subsequent interventional phase involving 483 patients, crews incorporated a high-sensitive point-of-care troponin test developed by QuidelOrtho (Mirage News). Troponin tests measure proteins released into the bloodstream when heart muscle is damaged, providing on-the-spot results in less than 20 minutes (Mirage News).
While awaiting the rapid blood test, paramedics evaluated the first four elements of the HEART-score: the patient’s medical history, age, electrocardiogram (ECG) abnormalities, and risk factors like smoking (Mirage News). Combining these parameters allows crews to assess a patient’s immediate risk of experiencing a major adverse cardiovascular event (MACE) such as a heart attack, stroke, or cardiac death before leaving the scene (Mirage News).
Impact on Emergency Department Referrals and Patient Safety
The operational shift yielded a marked change in patient disposition. In the baseline phase, only 19 patients, or 3.5%, were left at home or referred directly to a general practitioner (Mirage News). Following the implementation of the point-of-care troponin test and HEART-score protocol, that figure rose to 165 patients, or 34.2% (Mirage News). Over a third of patients avoided an emergency room visit entirely (Mirage News).
“Hospital referrals were reduced significantly, avoiding hospital overcrowding and unnecessary use of medical resources, while enabling more patients to avoid the stresses of the hospital environment. This is good for patients and good for hospitals.”
Photo: miragenews.com
Dr Barbra Backus, via Mirage News
To establish safe criteria for leaving patients at home, specific thresholds were enforced (Mirage News).
The HEART-score had to register as low risk (Mirage News).
The troponin test value had to remain below four nanograms per litre (Mirage News).
Crews had to find no clinical suspicion of other serious conditions such as pulmonary embolism, pneumothorax, or pancreatitis (Mirage News).
Patients left at home received explicit instructions to contact emergency services again if their symptoms did not resolve, recurred, or deteriorated (Mirage News).
Researchers tracked participating patients for a minimum of one month, with the majority maintaining over six months of follow-up data (Mirage News). With 86% of the follow-up complete, investigators noted that 109 patients, representing 12.4% of the cohort, developed a major adverse cardiovascular event within 30 days (Mirage News). Broken down by study phase, 15.0% of patients experienced a MACE event before the intervention compared to 9.8% after the high-sensitive point-of-care testing protocol was established (Mirage News).
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