The efficacy of the HEART score in prehospital settings

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.

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