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. 2023 May;31(5):202-209.
doi: 10.1007/s12471-023-01766-3. Epub 2023 Mar 29.

Improved prehospital triage for acute cardiac care: results from HART-c, a multicentre prospective study

Enrico R de Koning  1 , Saskia L M A Beeres  1 , Jan Bosch  2 , Barbra E Backus  1   3 , Wouter J Tietge  4 , Reza Alizadeh Dehnavi  5 , Rolf H H Groenwold  6   7 , Allena M Silvius  8 , Pepijn T S van Lierop  1 , J Wouter Jukema  1 , Martin J Schalij  1 , Mark J Boogers  9
Affiliations

Improved prehospital triage for acute cardiac care: results from HART-c, a multicentre prospective study

Enrico R de Koning et al. Neth Heart J. 2023 May.

Abstract

Background: Cardiac symptoms are one of the most prevalent reasons for emergency department visits. However, over 80% of patients with such symptoms are sent home after acute cardiovascular disease has been ruled out.

Objective: The Hollands-Midden Acute Regional Triage-cardiology (HART-c) study aimed to investigate whether a novel prehospital triage method, combining prehospital and hospital data with expert consultation, could increase the number of patients who could safely stay at home after emergency medical service (EMS) consultation.

Methods: The triage method combined prehospital EMS data, such as electrocardiographic and vital parameters in real time, and data from regional hospitals (including previous medical records and admission capacity) with expert consultation. During the 6‑month intervention and control periods 1536 and 1376 patients, respectively, were consulted by the EMS. The primary endpoint was the percentage change of patients who could stay at home after EMS consultation.

Results: The novel triage method led to a significant increase in patients who could safely stay at home, 11.8% in the intervention group versus 5.9% in the control group: odds ratio 2.31 (95% confidence interval (CI) 1.74-3.05). Of 181 patients staying at home, only 1 (< 1%) was later diagnosed with ACS; no patients died. Furthermore the number of interhospital transfers decreased: relative risk 0.81 (95% CI 0.67-0.97).

Conclusion: The HART‑c triage method led to a significant decrease in interhospital transfers and an increase in patients with cardiac symptoms who could safely stay at home. The presented method thereby reduced overcrowding and, if implemented throughout the country and for other medical specialties, could potentially reduce the number of cardiac and non-cardiac hospital visits even further.

Keywords: Hollands-Midden Acute Regional Triage—cardiology; Prehospital triage; Telemedicine.

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Conflict of interest statement

E.R. de Koning, S.L.M.A. Beeres, J. Bosch, W.J. Tietge, R. Alizadeh Dehnavi, R.H.H. Groenwold, A.M. Silvius, P.T.S. van Lierop, J.W. Jukema, M.J. Schalij and M.J. Boogers declare that they have no competing interests. B.E. Backus is the creator of the HEART score.

Figures

Fig. 1
Fig. 1
Triage method with a standard care and possible interhospital transfers in the case of overcrowded emergency department or nursing ward and b novel triage method combining prehospital data with live streaming of electrocardiographic and vital parameters, hospital data such as previous electrocardiograms, medical history and admission capacity as well as expert consultation
Fig. 2
Fig. 2
Percentage of patients with cardiac symptoms left at home in the control group (5.9%) and the intervention group (11.8%)
Fig. 3
Fig. 3
Percentage of patients with cardiac symptoms left at home by the emergency medical services in the control group and in the intervention group per month
See this image and copyright information in PMC

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