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  1. Article ; Online: Prehospital T-MACS and HEART scores in the prediction of myocardial infarction: a prospective evaluation.

    Cooper, Jamie G / Donaldson, Lorna A / Coutts, Amanda J / Body, Richard / Mills, Nicholas L

    Emergency medicine journal : EMJ

    2024  Volume 41, Issue 4, Page(s) 255–256

    MeSH term(s) Humans ; Myocardial Infarction/diagnosis ; Heart ; Emergency Medical Services ; Electrocardiography ; Thrombolytic Therapy
    Language English
    Publishing date 2024-03-21
    Publishing country England
    Document type Journal Article
    ZDB-ID 2040124-3
    ISSN 1472-0213 ; 1472-0205
    ISSN (online) 1472-0213
    ISSN 1472-0205
    DOI 10.1136/emermed-2023-213639
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Could paramedics use the HEART Pathway to identify patients at low-risk of myocardial infarction in the prehospital setting?

    Cooper, Jamie G / Ferguson, James / Donaldson, Lorna A / Black, Kim M M / Livock, Kate J / Horrill, Judith L / Davidson, Elaine M / Scott, Neil W / Lee, Amanda J / Fujisawa, Takeshi / Lee, Kuan Ken / Anand, Atul / Shah, Anoop S V / Mills, Nicholas L

    American heart journal

    2024  Volume 271, Page(s) 182–187

    Abstract: In the Emergency Department, patients with suspected myocardial infarction can be risk stratified using the HEART pathway, which has recently been amended for prehospital use and modified for the incorporation of a high-sensitivity cardiac troponin test. ...

    Abstract In the Emergency Department, patients with suspected myocardial infarction can be risk stratified using the HEART pathway, which has recently been amended for prehospital use and modified for the incorporation of a high-sensitivity cardiac troponin test. In a prospective analysis, the performance of both HEART pathways in the prehospital setting, with a high-sensitivity cardiac troponin test using 3 different thresholds, was evaluated for major adverse cardiac events at 30 days. We found that both low-risk HEART pathways, when using the most conservative cardiac troponin thresholds, approached but did not reach accepted rule-out performance in the Emergency Department.
    MeSH term(s) Humans ; Myocardial Infarction/diagnosis ; Myocardial Infarction/blood ; Emergency Medical Services/methods ; Prospective Studies ; Risk Assessment/methods ; Male ; Female ; Middle Aged ; Aged ; Biomarkers/blood ; Emergency Service, Hospital ; Allied Health Personnel ; Troponin/blood ; Emergency Medical Technicians ; Paramedics
    Chemical Substances Biomarkers ; Troponin
    Language English
    Publishing date 2024-03-30
    Publishing country United States
    Document type Journal Article
    ZDB-ID 80026-0
    ISSN 1097-6744 ; 0002-8703
    ISSN (online) 1097-6744
    ISSN 0002-8703
    DOI 10.1016/j.ahj.2024.02.018
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Performance of a prehospital HEART score in patients with possible myocardial infarction: a prospective evaluation.

    Cooper, Jamie G / Ferguson, James / Donaldson, Lorna A / Black, Kim M M / Livock, Kate J / Horrill, Judith L / Davidson, Elaine M / Scott, Neil W / Lee, Amanda J / Fujisawa, Takeshi / Lee, Kuan Ken / Anand, Atul / Shah, Anoop S V / Mills, Nicholas L

    Emergency medicine journal : EMJ

    2023  Volume 40, Issue 7, Page(s) 474–481

    Abstract: Introduction: The History, Electrocardiogram (ECG), Age, Risk Factors and Troponin (HEART) score is commonly used to risk stratify patients with possible myocardial infarction as low risk or high risk in the Emergency Department (ED). Whether the HEART ... ...

    Abstract Introduction: The History, Electrocardiogram (ECG), Age, Risk Factors and Troponin (HEART) score is commonly used to risk stratify patients with possible myocardial infarction as low risk or high risk in the Emergency Department (ED). Whether the HEART score can be used by paramedics to guide care were high-sensitivity cardiac troponin testing available in a prehospital setting is uncertain.
    Methods: In a prespecified secondary analysis of a prospective cohort study where paramedics enrolled patients with suspected myocardial infarction, a paramedic Heart, ECG, Age, Risk Factors (HEAR) score was recorded contemporaneously, and a prehospital blood sample was obtained for subsequent cardiac troponin testing. HEART and modified HEART scores were derived using laboratory contemporary and high-sensitivity cardiac troponin I assays. HEART and modified HEART scores of ≤3 and ≥7 were applied to define low-risk and high-risk patients, and performance was evaluated for an outcome of major adverse cardiac events (MACEs) at 30 days.
    Results: Between November 2014 and April 2018, 1054 patients were recruited, of whom 960 (mean 64 (SD 15) years, 42% women) were eligible for analysis and 255 (26%) experienced a MACE at 30 days. A HEART score of ≤3 identified 279 (29%) as low risk with a negative predictive value of 93.5% (95% CI 90.0% to 95.9%) for the contemporary assay and 91.4% (95% CI 87.5% to 94.2%) for the high-sensitivity assay. A modified HEART score of ≤3 using the limit of detection of the high-sensitivity assay identified 194 (20%) patients as low risk with a negative predictive value of 95.9% (95% CI 92.1% to 97.9%). A HEART score of ≥7 using either assay gave a lower positive predictive value than using the upper reference limit of either cardiac troponin assay alone.
    Conclusions: A HEART score derived by paramedics in the prehospital setting, even when modified to harness the precision of a high-sensitivity assay, does not allow safe rule-out of myocardial infarction or enhanced rule-in compared with cardiac troponin testing alone.
    MeSH term(s) Humans ; Female ; Male ; Prospective Studies ; Acute Coronary Syndrome/diagnosis ; Chest Pain/etiology ; Risk Assessment ; Myocardial Infarction ; Troponin I ; Emergency Service, Hospital ; Electrocardiography ; Biomarkers
    Chemical Substances Troponin I ; Biomarkers
    Language English
    Publishing date 2023-06-02
    Publishing country England
    Document type Journal Article
    ZDB-ID 2040124-3
    ISSN 1472-0213 ; 1472-0205
    ISSN (online) 1472-0213
    ISSN 1472-0205
    DOI 10.1136/emermed-2022-213003
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Could High-Sensitivity Cardiac Troponin Testing Rule Out Acute Myocardial Infarction in the Prehospital Setting?

    Cooper, Jamie G / Ferguson, James / Donaldson, Lorna A / Black, Kim M M / Horrill, Judith L / Davidson, Elaine M / Scott, Neil W / Fujisawa, Takeshi / Chapman, Andrew R / Mills, Nicholas L

    Journal of the American College of Cardiology

    2021  Volume 78, Issue 23, Page(s) 2392–2394

    MeSH term(s) Aged ; Biomarkers/blood ; Diagnosis, Differential ; Emergency Medical Services ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction/blood ; Myocardial Infarction/diagnosis ; Troponin T/blood
    Chemical Substances Biomarkers ; Troponin T
    Language English
    Publishing date 2021-11-30
    Publishing country United States
    Document type Letter ; Research Support, Non-U.S. Gov't
    ZDB-ID 605507-2
    ISSN 1558-3597 ; 0735-1097
    ISSN (online) 1558-3597
    ISSN 0735-1097
    DOI 10.1016/j.jacc.2021.10.004
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  5. Article ; Online: The Ambulance Cardiac Chest Pain Evaluation in Scotland Study (ACCESS): A Prospective Cohort Study.

    Cooper, Jamie G / Ferguson, James / Donaldson, Lorna A / Black, Kim M M / Livock, Kate J / Horrill, Judith L / Davidson, Elaine M / Scott, Neil W / Lee, Amanda J / Fujisawa, Takeshi / Lee, Kuan Ken / Anand, Atul / Shah, Anoop S V / Mills, Nicholas L

    Annals of emergency medicine

    2021  Volume 77, Issue 6, Page(s) 575–588

    Abstract: Study objective: To determine whether risk stratification in the out-of-hospital setting could identify patients with chest pain who are at low and high risk to avoid admission or aid direct transfer to cardiac centers.: Methods: Paramedics ... ...

    Abstract Study objective: To determine whether risk stratification in the out-of-hospital setting could identify patients with chest pain who are at low and high risk to avoid admission or aid direct transfer to cardiac centers.
    Methods: Paramedics prospectively enrolled patients with suspected acute coronary syndrome without diagnostic ST-segment elevation on the ECG. The History, ECG, Age and Risk Factors (HEAR) score was recorded contemporaneously, and out-of-hospital samples were obtained to measure cardiac Troponin I (cTnI) level on a point-of-care device, to allow calculation of the History, ECG, Age, Risk Factors, and Troponin (HEART) score. HEAR and HEART scores less than or equal to 3 and greater than or equal to 7 were defined as low and high risk for major adverse cardiac events at 30 days.
    Results: Of 1,054 patients (64 years [SD 15 years]; 42% women), 284 (27%) experienced a major adverse cardiac event at 30 days. The HEAR score was calculated in all patients, with point-of-care cTnI testing available in 357 (34%). A HEAR score less than or equal to 3 identified 32% of patients (334/1,054) as low risk, with a sensitivity of 84.9% (95% confidence interval [CI] 80.7% to 89%), whereas a score greater than or equal to 7 identified just 3% of patients (30/1,054) as high risk, with a specificity of 98.7% (95% CI 97.9% to 99.5%). A point-of-care HEART score less than or equal to 3 identified a similar proportion as low risk (30%), with a sensitivity of 87.0% (95% CI 80.7% to 93.4%), whereas a score greater than or equal to 7 identified 14% as high risk, with a specificity of 94.8% (95% CI 92.0% to 97.5%).
    Conclusion: Paramedics can use the HEAR score to discriminate risk, but even when used in combination with out-of-hospital point-of-care cTnI testing, the HEART score does not safely rule out major adverse cardiac events, and only a small proportion of patients are identified as high risk.
    MeSH term(s) Aged ; Ambulances ; Biomarkers/blood ; Cardiac Care Facilities/statistics & numerical data ; Chest Pain/diagnosis ; Electrocardiography ; Female ; Humans ; Male ; Middle Aged ; Patient Admission/statistics & numerical data ; Patient Transfer/statistics & numerical data ; Prospective Studies ; Risk Assessment/methods ; Risk Factors ; Scotland ; Troponin T/blood
    Chemical Substances Biomarkers ; Troponin T
    Language English
    Publishing date 2021-04-27
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 603080-4
    ISSN 1097-6760 ; 0196-0644
    ISSN (online) 1097-6760
    ISSN 0196-0644
    DOI 10.1016/j.annemergmed.2021.01.012
    Database MEDical Literature Analysis and Retrieval System OnLINE

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