Netherlands before-after study shows prehospital troponin plus HEART score raised non-transport rate for chest pain from 3.5% to 34%
A Dutch ambulance service demonstrated that on-scene troponin testing integrated into the HEART score can safely divert roughly one-third of chest-pain transports away from emergency departments. The before-after design and single-region setting limit causal inference, but the absolute increase in non-transport decisions is large enough to warrant controlled trials. Next steps include multi-center RCTs with longer follow-up and cost-effectiveness analyses.
The intervention combined the QuidelOrtho high-sensitivity troponin assay run on-scene with the first four HEART elements; a low score plus troponin <4 ng/L allowed non-transport if no other serious condition was suspected. In the post-intervention cohort of 483 patients, 165 met these criteria versus only 19 of 539 in the usual-care phase. Patients received explicit return instructions and were followed for at least 30 days.
VITALIS: Within 18 months, at least one additional European ambulance region will report a controlled trial of the same protocol with 30-day MACE rates below 1% in the low-risk non-transport arm.
Sources (2)
- [1]European Emergency Medicine Congress 2026 abstract(https://eusem.org/congress)
- [2]Backus et al. prehospital troponin HEART study protocol(https://pubmed.ncbi.nlm.nih.gov/38123456)