PreHEART score for emergency medical services triage of chest pain: a randomised trial
In brief
PreHEART triage raises non-transport from 25% to 35% without more serious events
In a randomized trial of 5,170 adults with chest pain, emergency crews using PreHEART transported fewer patients, while serious adverse events at three days were no more frequent than with usual care. The approach also reduced 30-day emergency presentations and costs; increased detection of acute coronary syndrome in women was not robust after statistical correction.
- Journal
- Heart (British Cardiac Society) (Q1)
- Published
- 29 September 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Dennis C Sagel, Pieter J Vlaar, Duolao Wang, Jesse Demandt, Wybe Nieuwland, Roelof Lettinga, et al.
- PMID
- 42810856
- DOI
- 10.1136/heartjnl-2026-328924
Why clinicians should know about it
- Picked for Cardiology and Cardiovascular Medicine (paper of the day, 30 September 2026): PreHEART-guided EMS conveyance non‑inferior, reduces ED visits
- Picked for Emergency Medicine (paper of the day, 30 September 2026): PreHEART-guided EMS conveyance non‑inferior, reduces ED presentations
- Picked for Family Practice (paper of the day, 30 September 2026): PreHEART EMS chest pain trial, informs acute care pathways
Abstract
BACKGROUND: Triage and support in conveyance decision making of patients with undifferentiated chest pain is the next chapter after validation of the PreHEART score. The PreHEART 3 study tests whether a PreHEART score-guided emergency medical services (EMSs) conveyance is non-inferior to usual care with respect to unexpected serious adverse events in adults attended by EMS for undifferentiated chest pain. METHODS: Pragmatic, randomised, open-label, blinded-endpoint non-inferiority trial was conducted in the Netherlands by Emergency Medical Services. 5170 adults attended by EMS for undifferentiated chest pain, randomised 1:1 to a conveyance decision guided by the prehospital PreHEART score versus usual care. Main outcome measures hierarchical composite of unexpected serious adverse events at 3 days, analysed by win ratio (non-inferiority threshold: lower bound of the 95% CI >0.80). RESULTS: PreHEART-guided care was non-inferior (win ratio 1.01; 95% CI 0.89 to 1.16; p<0.001), with no deaths within 3 days among 1526 non-conveyed patients. It increased non-conveyance (34.6% vs 24.5%), reduced 30-day emergency presentations (risk ratio (RR) 0.88) and lowered costs (-€345). In women, acute coronary syndrome (ACS) diagnosis (RR 1.48) and angiography (RR 1.66) increased; multiplicative interactions were nominally significant but not after Holm correction. CONCLUSIONS : PreHEART-guided EMS conveyance was non-inferior to usual care for serious adverse events, reduced emergency department presentations and costs, and was associated with increased ACS detection and coronary angiography in women. TRIAL REGISTRATION NUMBER: NL-OMON27238.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.