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Operations & systems
Risk-score-guided conveyance safe in chest pain
PreHEART score for emergency medical services triage of chest pain: a randomised trial
Heart · 2026-09-29 · Added 3 October 2026
A Dutch pragmatic RCT testing whether a prehospital risk score could guide ambulance conveyance in 5170 adults with undifferentiated chest pain — it was non-inferior to usual care for 3-day serious adverse events while increasing non-conveyance, cutting 30-day ED presentations and lowering costs.
- Study type
- RCT
- Design
- Pragmatic randomised open-label blinded-endpoint non-inferiority trial
- Participants
- 5170 adults with undifferentiated chest pain
- Main finding
- PreHEART-guided conveyance non-inferior for 3-day unexpected serious adverse events (win ratio 1.01, 95% CI 0.89–1.16); non-conveyance rose to 34.6% vs 24.5%, 30-day emergency presentations fell (RR 0.88), costs −€345, and no deaths within 3 days among 1526 non-conveyed patients
- Caveat
- Open-label trial in a Dutch EMS system with its own consult-and-convey structure; the signals for increased ACS detection in women were nominal and didn't survive multiplicity correction
- Bottom line
- Hypothesis-generating
Why it matters in Australia (Medium relevance). Non-conveyance pathways exist across Australian services, but validated chest-pain decision tools aren't routine on Australian ambulances — this is the strongest evidence yet that they're safe, and it directly informs the keep-at-home debate.
Learning goal
Weigh the safety of risk-score-guided non-conveyance when triaging adults with undifferentiated chest pain.
More
- Topic: Operations & systems
- Daily scan: 3 October 2026
- Podcast: Paramedic Papers Daily, 3 October 2026
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