ArticleNetherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation2026
Performance of the HEART Score in pre-hospital settings for suspected non-ST-elevation acute coronary syndrome: The POPular HEART Study.
Article in Netherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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- Technology and evidence in daily cardiovascular practice.Netherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation · 2026Article
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11 authors.
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Abstract
backgroundThe HEART (history, ECG, age, risk factors, and troponin) score is used to stratify patients with chest pain into low- or higher-risk for major adverse cardiac events (MACE). We assessed the diagnostic performance and interobserver agreement of the pre-hospital HEART score for ruling out myocardial infarction (MI) and MACE.
methodsThis prospective, multicentre study included 383 patients with suspected non-ST-elevation acute coronary syndrome. Patients with both a pre-hospital and in-hospital HEART scores were analysed (n = 331). Prehospital HEART scores (based on point-of-care troponin) were assessed by ambulance personnel, and in-hospital HEART scores (based on the European Society of Cardiology 0/1-hour high-sensitivity troponin algorithm) were assessed by emergency physicians blinded to the pre-hospital scores. Endpoints were interobserver agreement (intraclass correlation coefficient, ICC) and diagnostic performance for ruling out MI and MACE at 30 days.
resultsAmong the 331 patients (mean age: 65 years, 48% women), 26% were classified as low risk (pre-hospital HEART ≤ 3) of whom 4.7% had an index-admission NSTEMI. Of the patients with HEART score > 3, 12.1% experienced MACE. Interobserver agreement between the pre- and in-hospital HEART scores was moderate (ICC, 0.653), with the lowest concordance for history and ECG. The pre-hospital HEART score yielded a negative predictive value of 95.33% and a sensitivity of 91.7% for MACE at 30 days.
conclusionPre- and in-hospital HEART scores showed moderate agreement. The 30-day MACE rate (4.7%) in the pre-hospital low-risk group indicates that improved training in history and ECG assessment, and use of high-sensitivity assays are required.
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