References
The efficacy of the HEART score in prehospital settings
Abstract
Background:
HEART scores are a well-validated tool used to risk stratify patients with chest pain in the emergency department. Currently, no triage or risk stratification tool is available in the UK prehospital arena.
Methods:
A comprehensive literature search was carried out to determine the effectiveness of HEART score use by paramedics in the prehospital environment.
Findings:
Prehospital HEART scores completed by paramedics appear to have a high sensitivity and negative predictive value for detecting major adverse cardiac events. The use of high-sensitivity cardiac troponin assays or a prehospital modified HEART Pathway may allow patients to be triaged based on a single point-of-care (POC) cardiac troponin test. As POC devices improve, this is likely to increase the accuracy of paramedic HEART scores. Additionally, there are some differences between HEART scores calculated by doctors and paramedics.
Conclusion:
The use of HEART scores prehospitally has the potential to improve patient outcomes. However, issues remain over the accuracy of POC devices and with paramedic interpretation of electrocardiograms and cardiac history-taking. Furthermore, the lack of POC testing in current UK paramedic scopes of practice raises questions over the practicality of introducing HEART scores, which would rely on POC testing.
Chest pain is one of the most common presentations to emergency departments (EDs) and ambulance services alike, accounting for approximately 10% of UK ambulance responses (Best, 2017; Turner et al, 2017; Pedersen et al, 2019).
Being able to identify the aetiology of chest pain is a core component of paramedic practice as it has many life-threatening causes, including ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI), aortic dissection, pericarditis and oesophageal perforation.
European Society of Cardiology guidelines and UK research highlight that NSTEMI has a greater prevalence than STEMI (in a ratio of approximately 2:1) as a cause of acute chest pain (Ibanez et al, 2018; Myocardial Ischaemia National Audit Project (MINAP), 2021).
Notwithstanding other clinical reasons (such as inadequate analgesia), the lack of biochemical tests in a prehospital environment means many patients with chest pain (without STEMI) are transported to the ED only to be discharged after a blood test. This is caused by a lack of prehospital capability to use and measure cardiac biomarkers as part of the decision-making process in this population (Wibring et al, 2016; Pedersen et al, 2019).
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