2024
Goaris W A Aarts, Cyril Camaro, Eddy M M Adang, Laura Rodwell, Roger van Hout, Gijs Brok, Anouk Hoare, Frank de Pooter, Walter de Wit, Gilbert E Cramer, Roland R J van Kimmenade, Eva Ouwendijk, Martijn H Rutten, Erwin Zegers, Robert-Jan M van Geuns, Marc E R Gomes, Peter Damman, Niels van Royen
Pre-hospital rule-out of non-ST-segment elevation acute coronary syndrome by a single troponin: final one-year outcomes of the ARTICA randomised trial Tijdschriftartikel
In: Eur Heart J Qual Care Clin Outcomes, vol. 10, nr. 5, pp. 411–420, 2024, ISSN: 2058-1742.
@article{pmid38236708,
title = {Pre-hospital rule-out of non-ST-segment elevation acute coronary syndrome by a single troponin: final one-year outcomes of the ARTICA randomised trial},
author = {Goaris W A Aarts and Cyril Camaro and Eddy M M Adang and Laura Rodwell and Roger van Hout and Gijs Brok and Anouk Hoare and Frank de Pooter and Walter de Wit and Gilbert E Cramer and Roland R J van Kimmenade and Eva Ouwendijk and Martijn H Rutten and Erwin Zegers and Robert-Jan M van Geuns and Marc E R Gomes and Peter Damman and Niels van Royen},
doi = {10.1093/ehjqcco/qcae004},
issn = {2058-1742},
year = {2024},
date = {2024-08-01},
journal = {Eur Heart J Qual Care Clin Outcomes},
volume = {10},
number = {5},
pages = {411--420},
abstract = {BACKGROUND AND AIMS: The healthcare burden of acute chest pain is enormous. In the randomized ARTICA trial, we showed that pre-hospital identification of low-risk patients and rule-out of non-ST-segment elevation acute coronary syndrome (NSTE-ACS) with point-of-care (POC) troponin measurement reduces 30-day healthcare costs with low major adverse cardiac events (MACE) incidence. Here we present the final 1-year results of the ARTICA trial.nnMETHODS: Low-risk patients with suspected NSTE-ACS were randomized to pre-hospital rule-out with POC troponin measurement or emergency department (ED) transfer. Primary 1-year outcome was healthcare costs. Secondary outcomes were safety, quality of life (QoL), and cost-effectiveness. Safety was defined as a 1-year MACE consisting of ACS, unplanned revascularization, or all-cause death. QoL was measured with EuroQol-5D-5L questionnaires. Cost-effectiveness was defined as 1-year healthcare costs difference per QoL difference.nnRESULTS: Follow-up was completed for all 863 patients. Healthcare costs were significantly lower in the pre-hospital strategy (€1932 ± €2784 vs. €2649 ± €2750), mean difference €717 [95% confidence interval (CI) €347 to €1087; P < 0.001]. In the total population, the 1-year MACE rate was comparable between groups [5.1% (22/434) in the pre-hospital strategy vs. 4.2% (18/429) in the ED strategy; P = 0.54]. In the ruled-out ACS population, 1-year MACE remained low [1.7% (7/419) vs. 1.4% (6/417)], risk difference 0.2% (95% CI -1.4% to 1.9%; P = 0.79). QoL showed no significant difference between strategies.nnCONCLUSIONS: Pre-hospital rule-out of NSTE-ACS with POC troponin testing in low-risk patients is cost-effective, as expressed by a sustainable healthcare cost reduction and no significant effect on QoL. One-year MACE remained low for both strategies.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND AND AIMS: The healthcare burden of acute chest pain is enormous. In the randomized ARTICA trial, we showed that pre-hospital identification of low-risk patients and rule-out of non-ST-segment elevation acute coronary syndrome (NSTE-ACS) with point-of-care (POC) troponin measurement reduces 30-day healthcare costs with low major adverse cardiac events (MACE) incidence. Here we present the final 1-year results of the ARTICA trial.nnMETHODS: Low-risk patients with suspected NSTE-ACS were randomized to pre-hospital rule-out with POC troponin measurement or emergency department (ED) transfer. Primary 1-year outcome was healthcare costs. Secondary outcomes were safety, quality of life (QoL), and cost-effectiveness. Safety was defined as a 1-year MACE consisting of ACS, unplanned revascularization, or all-cause death. QoL was measured with EuroQol-5D-5L questionnaires. Cost-effectiveness was defined as 1-year healthcare costs difference per QoL difference.nnRESULTS: Follow-up was completed for all 863 patients. Healthcare costs were significantly lower in the pre-hospital strategy (€1932 ± €2784 vs. €2649 ± €2750), mean difference €717 [95% confidence interval (CI) €347 to €1087; P < 0.001]. In the total population, the 1-year MACE rate was comparable between groups [5.1% (22/434) in the pre-hospital strategy vs. 4.2% (18/429) in the ED strategy; P = 0.54]. In the ruled-out ACS population, 1-year MACE remained low [1.7% (7/419) vs. 1.4% (6/417)], risk difference 0.2% (95% CI -1.4% to 1.9%; P = 0.79). QoL showed no significant difference between strategies.nnCONCLUSIONS: Pre-hospital rule-out of NSTE-ACS with POC troponin testing in low-risk patients is cost-effective, as expressed by a sustainable healthcare cost reduction and no significant effect on QoL. One-year MACE remained low for both strategies.
Cyril Camaro, Goaris W A Aarts, Niels van Royen
Less concern about missing NSTEMIs, more prospective randomized controlled trials warranted Diversen
2024, ISSN: 1522-9645.
@misc{pmid37787622,
title = {Less concern about missing NSTEMIs, more prospective randomized controlled trials warranted},
author = {Cyril Camaro and Goaris W A Aarts and Niels van Royen},
doi = {10.1093/eurheartj/ehad646},
issn = {1522-9645},
year = {2024},
date = {2024-01-01},
journal = {Eur Heart J},
volume = {45},
number = {2},
pages = {144},
keywords = {},
pubstate = {published},
tppubtype = {misc}
}
2023
Goaris W A Aarts, Cyril Camaro, Laura Rodwell, Eddy M M Adang, Roger van Hout, Gijs Brok, Anouk Hoare, Frank P C de Pooter, Walter de Wit, Gilbert E Cramer, Roland R J van Kimmenade, Eva Ouwendijk, Martijn Rutten, Erwin Zegers, Robert-Jan M van Geuns, Marc E R Gomes, Peter Damman, Niels van Royen
Differences in risk and costs between prehospital identified low-risk men and women with chest pain Tijdschriftartikel
In: Open Heart, vol. 10, nr. 2, 2023, ISSN: 2053-3624.
@article{pmid38011992,
title = {Differences in risk and costs between prehospital identified low-risk men and women with chest pain},
author = {Goaris W A Aarts and Cyril Camaro and Laura Rodwell and Eddy M M Adang and Roger van Hout and Gijs Brok and Anouk Hoare and Frank P C de Pooter and Walter de Wit and Gilbert E Cramer and Roland R J van Kimmenade and Eva Ouwendijk and Martijn Rutten and Erwin Zegers and Robert-Jan M van Geuns and Marc E R Gomes and Peter Damman and Niels van Royen},
doi = {10.1136/openhrt-2023-002390},
issn = {2053-3624},
year = {2023},
date = {2023-11-01},
journal = {Open Heart},
volume = {10},
number = {2},
abstract = {OBJECTIVE: Prehospital rule-out of non-ST-segment elevation acute coronary syndrome (NSTE-ACS) in low-risk patient with a point-of-care troponin measurement reduces healthcare costs with similar safety to standard transfer to the hospital. Risk stratification is performed identical for men and women, despite important differences in clinical presentation, risk factors and age between men and women with NSTE-ACS. Our aim was to compare safety and healthcare costs between men and women in prehospital identified low-risk patients with suspected NSTE-ACS.nnMETHODS: In the Acute Rule-out of non-ST-segment elevation acute coronary syndrome in the (pre)hospital setting by HEART (History, ECG, Age, Risk factors and Troponin) score assessment and a single poInt of CAre troponin randomised trial, the HEAR (History, ECG, Age and Risk factors) score was assessed by ambulance paramedics in suspected NSTE-ACS patients. Low-risk patients (HEAR score ≤3) were included. In this substudy, men and women were compared. Primary endpoint was 30-day major adverse cardiac events (MACE), secondary endpoints were 30-day healthcare costs and the scores for the HEAR score components.nnRESULTS: A total of 863 patients were included, of which 495 (57.4%) were women. Follow-up was completed in all patients. In the total population, MACE occurred in 6.8% of the men and 1.6% of the women (risk ratio (RR) 4.2 (95% CI 1.9 to 9.2, p<0.001)). In patients with ruled-out ACS (97% of the total population), MACE occurred in 1.4% of the men and in 0.2% of the women (RR 7.0 (95% CI 2.0 to 14.2, p<0.001). Mean healthcare costs were €504.55 (95% CI €242.22 to €766.87, p<0.001) higher in men, mainly related to MACE.nnCONCLUSIONS: In a prehospital population of low-risk suspected NSTE-ACS patients, 30-day incidence of MACE and MACE-related healthcare costs were significantly higher in men than in women.nnTRIAL REGISTRATION NUMBER: NCT05466591.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
OBJECTIVE: Prehospital rule-out of non-ST-segment elevation acute coronary syndrome (NSTE-ACS) in low-risk patient with a point-of-care troponin measurement reduces healthcare costs with similar safety to standard transfer to the hospital. Risk stratification is performed identical for men and women, despite important differences in clinical presentation, risk factors and age between men and women with NSTE-ACS. Our aim was to compare safety and healthcare costs between men and women in prehospital identified low-risk patients with suspected NSTE-ACS.nnMETHODS: In the Acute Rule-out of non-ST-segment elevation acute coronary syndrome in the (pre)hospital setting by HEART (History, ECG, Age, Risk factors and Troponin) score assessment and a single poInt of CAre troponin randomised trial, the HEAR (History, ECG, Age and Risk factors) score was assessed by ambulance paramedics in suspected NSTE-ACS patients. Low-risk patients (HEAR score ≤3) were included. In this substudy, men and women were compared. Primary endpoint was 30-day major adverse cardiac events (MACE), secondary endpoints were 30-day healthcare costs and the scores for the HEAR score components.nnRESULTS: A total of 863 patients were included, of which 495 (57.4%) were women. Follow-up was completed in all patients. In the total population, MACE occurred in 6.8% of the men and 1.6% of the women (risk ratio (RR) 4.2 (95% CI 1.9 to 9.2, p<0.001)). In patients with ruled-out ACS (97% of the total population), MACE occurred in 1.4% of the men and in 0.2% of the women (RR 7.0 (95% CI 2.0 to 14.2, p<0.001). Mean healthcare costs were €504.55 (95% CI €242.22 to €766.87, p<0.001) higher in men, mainly related to MACE.nnCONCLUSIONS: In a prehospital population of low-risk suspected NSTE-ACS patients, 30-day incidence of MACE and MACE-related healthcare costs were significantly higher in men than in women.nnTRIAL REGISTRATION NUMBER: NCT05466591.
Goaris W A Aarts, Cyril Camaro, Niels van Royen
Ready for rapid rule-out of acute myocardial infarction Tijdschriftartikel
In: Eur Heart J, vol. 44, nr. 38, pp. 3889–3891, 2023, ISSN: 1522-9645.
@article{pmid37592857,
title = {Ready for rapid rule-out of acute myocardial infarction},
author = {Goaris W A Aarts and Cyril Camaro and Niels van Royen},
doi = {10.1093/eurheartj/ehad519},
issn = {1522-9645},
year = {2023},
date = {2023-10-01},
journal = {Eur Heart J},
volume = {44},
number = {38},
pages = {3889--3891},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Cyril Camaro, Goaris W A Aarts, Eddy M M Adang, Roger van Hout, Gijs Brok, Anouk Hoare, Laura Rodwell, Frank de Pooter, Walter de Wit, Gilbert E Cramer, Roland R J van Kimmenade, Peter Damman, Eva Ouwendijk, Martijn Rutten, Erwin Zegers, Robert-Jan M van Geuns, Marc E R Gomes, Niels van Royen
Rule-out of non-ST-segment elevation acute coronary syndrome by a single, pre-hospital troponin measurement: a randomized trial Tijdschriftartikel
In: Eur Heart J, vol. 44, nr. 19, pp. 1705–1714, 2023, ISSN: 1522-9645.
@article{pmid36755110,
title = {Rule-out of non-ST-segment elevation acute coronary syndrome by a single, pre-hospital troponin measurement: a randomized trial},
author = {Cyril Camaro and Goaris W A Aarts and Eddy M M Adang and Roger van Hout and Gijs Brok and Anouk Hoare and Laura Rodwell and Frank de Pooter and Walter de Wit and Gilbert E Cramer and Roland R J van Kimmenade and Peter Damman and Eva Ouwendijk and Martijn Rutten and Erwin Zegers and Robert-Jan M van Geuns and Marc E R Gomes and Niels van Royen},
doi = {10.1093/eurheartj/ehad056},
issn = {1522-9645},
year = {2023},
date = {2023-05-01},
journal = {Eur Heart J},
volume = {44},
number = {19},
pages = {1705--1714},
abstract = {AIMS: Patients with suspected non-ST-segment elevation acute coronary syndrome (NSTE-ACS) are routinely transferred to the emergency department (ED). A clinical risk score with point-of-care (POC) troponin measurement might enable ambulance paramedics to identify low-risk patients in whom ED evaluation is unnecessary. The aim was to assess safety and healthcare costs of a pre-hospital rule-out strategy using a POC troponin measurement in low-risk suspected NSTE-ACS patients.nnMETHODS AND RESULTS: This investigator-initiated, randomized clinical trial was conducted in five ambulance regions in the Netherlands. Suspected NSTE-ACS patients with HEAR (History, ECG, Age, Risk factors) score ≤3 were randomized to pre-hospital rule-out with POC troponin measurement or direct transfer to the ED. The sample size calculation was based on the primary outcome of 30-day healthcare costs. Secondary outcome was safety, defined as 30-day major adverse cardiac events (MACE), consisting of ACS, unplanned revascularization or all-cause death. : A total of 863 participants were randomized. Healthcare costs were significantly lower in the pre-hospital strategy (€1349 ± €2051 vs. €1960 ± €1808) with a mean difference of €611 [95% confidence interval (CI): 353-869; P < 0.001]. In the total population, MACE were comparable between groups [3.9% (17/434) in pre-hospital strategy vs. 3.7% (16/429) in ED strategy; P = 0.89]. In the ruled-out ACS population, MACE were very low [0.5% (2/419) vs. 1.0% (4/417)], with a risk difference of -0.5% (95% CI -1.6%-0.7%; P = 0.41) in favour of the pre-hospital strategy.nnCONCLUSION: Pre-hospital rule-out of ACS with a POC troponin measurement in low-risk patients significantly reduces healthcare costs while incidence of MACE was low in both strategies.nnTRIAL REGISTRATION: Clinicaltrials.gov identifier NCT05466591 and International Clinical Trials Registry Platform id NTR 7346.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
AIMS: Patients with suspected non-ST-segment elevation acute coronary syndrome (NSTE-ACS) are routinely transferred to the emergency department (ED). A clinical risk score with point-of-care (POC) troponin measurement might enable ambulance paramedics to identify low-risk patients in whom ED evaluation is unnecessary. The aim was to assess safety and healthcare costs of a pre-hospital rule-out strategy using a POC troponin measurement in low-risk suspected NSTE-ACS patients.nnMETHODS AND RESULTS: This investigator-initiated, randomized clinical trial was conducted in five ambulance regions in the Netherlands. Suspected NSTE-ACS patients with HEAR (History, ECG, Age, Risk factors) score ≤3 were randomized to pre-hospital rule-out with POC troponin measurement or direct transfer to the ED. The sample size calculation was based on the primary outcome of 30-day healthcare costs. Secondary outcome was safety, defined as 30-day major adverse cardiac events (MACE), consisting of ACS, unplanned revascularization or all-cause death. : A total of 863 participants were randomized. Healthcare costs were significantly lower in the pre-hospital strategy (€1349 ± €2051 vs. €1960 ± €1808) with a mean difference of €611 [95% confidence interval (CI): 353-869; P < 0.001]. In the total population, MACE were comparable between groups [3.9% (17/434) in pre-hospital strategy vs. 3.7% (16/429) in ED strategy; P = 0.89]. In the ruled-out ACS population, MACE were very low [0.5% (2/419) vs. 1.0% (4/417)], with a risk difference of -0.5% (95% CI -1.6%-0.7%; P = 0.41) in favour of the pre-hospital strategy.nnCONCLUSION: Pre-hospital rule-out of ACS with a POC troponin measurement in low-risk patients significantly reduces healthcare costs while incidence of MACE was low in both strategies.nnTRIAL REGISTRATION: Clinicaltrials.gov identifier NCT05466591 and International Clinical Trials Registry Platform id NTR 7346.
Goaris W A Aarts, Peter Damman
Clinical decision rules in the pre-hospital triage of patients with chest pain Diversen
2023, ISSN: 1568-5888.
@misc{pmid36917441,
title = {Clinical decision rules in the pre-hospital triage of patients with chest pain},
author = {Goaris W A Aarts and Peter Damman},
doi = {10.1007/s12471-023-01769-0},
issn = {1568-5888},
year = {2023},
date = {2023-04-01},
journal = {Neth Heart J},
volume = {31},
number = {4},
pages = {131--132},
keywords = {},
pubstate = {published},
tppubtype = {misc}
}
2022
C Camaro, G W A Aarts, N van Royen,
2022, ISSN: 1568-5888.
@misc{pmid36260200,
title = {Pre-hospital rule-out of acute coronary syndrome by modified HEART score assessment including point-of-care troponin},
author = {C Camaro and G W A Aarts and N van Royen and },
doi = {10.1007/s12471-022-01726-3},
issn = {1568-5888},
year = {2022},
date = {2022-11-01},
journal = {Neth Heart J},
volume = {30},
number = {11},
pages = {535},
keywords = {},
pubstate = {published},
tppubtype = {misc}
}
2020
G W A Aarts, K van der Wulp, C Camaro
Pre-hospital point-of-care troponin measurement: a clinical example of its additional value Tijdschriftartikel
In: Neth Heart J, vol. 28, nr. 10, pp. 514–519, 2020, ISSN: 1568-5888.
@article{pmid32514934,
title = {Pre-hospital point-of-care troponin measurement: a clinical example of its additional value},
author = {G W A Aarts and K van der Wulp and C Camaro},
doi = {10.1007/s12471-020-01434-w},
issn = {1568-5888},
year = {2020},
date = {2020-10-01},
journal = {Neth Heart J},
volume = {28},
number = {10},
pages = {514--519},
abstract = {In the majority of patients with chest pain, an acute coronary syndrome (ACS) can be ruled out. However, early recognition of an ACS is required in order to start treatment as soon as possible and reduce risks associated with myocardial ischaemia. Because of the lack of pre-hospital protocols to rule out an ACS, patients with a suspected ACS are transported to the emergency department, where the HEART score can be used to estimate the risk of major adverse cardiac events (MACE). Patients with a low HEART score have a low risk of MACE. A point-of-care (POC) troponin measurement enables ambulance paramedics to calculate the HEART score in the pre-hospital setting. POC troponin measurement and HEART score assessment have several potential advantages, including early recognition of an ACS and identification of high-risk patients before hospital arrival. Moreover, pre-hospital rule-out of an ACS could prevent unnecessary emergency department visits. The safety and cost-effectiveness of referring low-risk patients with a normal POC troponin value to the general practitioner are currently being investigated in the ARTICA randomised trial. This point-of-view article demonstrates one of the potential advantages of early detection of an ACS.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
In the majority of patients with chest pain, an acute coronary syndrome (ACS) can be ruled out. However, early recognition of an ACS is required in order to start treatment as soon as possible and reduce risks associated with myocardial ischaemia. Because of the lack of pre-hospital protocols to rule out an ACS, patients with a suspected ACS are transported to the emergency department, where the HEART score can be used to estimate the risk of major adverse cardiac events (MACE). Patients with a low HEART score have a low risk of MACE. A point-of-care (POC) troponin measurement enables ambulance paramedics to calculate the HEART score in the pre-hospital setting. POC troponin measurement and HEART score assessment have several potential advantages, including early recognition of an ACS and identification of high-risk patients before hospital arrival. Moreover, pre-hospital rule-out of an ACS could prevent unnecessary emergency department visits. The safety and cost-effectiveness of referring low-risk patients with a normal POC troponin value to the general practitioner are currently being investigated in the ARTICA randomised trial. This point-of-view article demonstrates one of the potential advantages of early detection of an ACS.
G W A Aarts, J Q Mol, C Camaro, J Lemkes, N van Royen, P Damman
Recent developments in diagnosis and risk stratification of non-ST-elevation acute coronary syndrome Tijdschriftartikel
In: Neth Heart J, vol. 28, nr. Suppl 1, pp. 88–92, 2020, ISSN: 1568-5888.
@article{pmid32780337,
title = {Recent developments in diagnosis and risk stratification of non-ST-elevation acute coronary syndrome},
author = {G W A Aarts and J Q Mol and C Camaro and J Lemkes and N van Royen and P Damman},
doi = {10.1007/s12471-020-01457-3},
issn = {1568-5888},
year = {2020},
date = {2020-08-01},
journal = {Neth Heart J},
volume = {28},
number = {Suppl 1},
pages = {88--92},
abstract = {In the past year, a number of important papers have been published on non-ST-elevation acute coronary syndrome, highlighting progress in clinical care. The current review focuses on early diagnosis and risk stratification using biomarkers and advances in intracoronary imaging.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
In the past year, a number of important papers have been published on non-ST-elevation acute coronary syndrome, highlighting progress in clinical care. The current review focuses on early diagnosis and risk stratification using biomarkers and advances in intracoronary imaging.
Goaris W A Aarts, Cyril Camaro, Robert-Jan van Geuns, Etienne Cramer, Roland R J van Kimmenade, P Damman, Pierre M van Grunsven, Eddy Adang, Paul Giesen, Martijn Rutten, Olaf Ouwendijk, Marc E R Gomes, Niels van Royen
In: BMJ Open, vol. 10, nr. 2, pp. e034403, 2020, ISSN: 2044-6055.
@article{pmid32071186,
title = {Acute rule-out of non-ST-segment elevation acute coronary syndrome in the (pre)hospital setting by HEART score assessment and a single point-of-care troponin: rationale and design of the ARTICA randomised trial},
author = {Goaris W A Aarts and Cyril Camaro and Robert-Jan van Geuns and Etienne Cramer and Roland R J van Kimmenade and P Damman and Pierre M van Grunsven and Eddy Adang and Paul Giesen and Martijn Rutten and Olaf Ouwendijk and Marc E R Gomes and Niels van Royen},
doi = {10.1136/bmjopen-2019-034403},
issn = {2044-6055},
year = {2020},
date = {2020-02-01},
journal = {BMJ Open},
volume = {10},
number = {2},
pages = {e034403},
abstract = {INTRODUCTION: Because of the lack of prehospital protocols to rule out a non-ST-segment elevation acute coronary syndrome (NSTE-ACS), patients with chest pain are often transferred to the emergency department (ED) for thorough evaluation. However, in low-risk patients, an ACS is rarely found, resulting in unnecessary healthcare consumption. Using the HEART (History, ECG, Age, Risk factors and Troponin) score, low-risk patients are easily identified. When a point-of-care (POC) troponin measurement is included in the HEART score, an ACS can adequately be ruled out in low-risk patients in the prehospital setting. However, it remains unclear whether a prehospital rule-out strategy using the HEART score and a POC troponin measurement in patients with suspected NSTE-ACS is cost-effective.nnMETHODS AND ANALYSIS: The ARTICA trial is a randomised trial in which the primary objective is to investigate the cost-effectiveness after 30 days of an early rule-out strategy for low-risk patients suspected of a NSTE-ACS, using a modified HEART score including a POC troponin T measurement. Patients are included by ambulance paramedics and 1:1 randomised for (1) presentation at the ED (control group) or (2) POC troponin T measurement (intervention group) and transfer of the care to the general practitioner in case of a low troponin T value. In total, 866 patients will be included. Follow-up will be performed after 30 days, 6 months and 12 months.nnETHICS AND DISSEMINATION: This trial has been accepted by the Medical Research Ethics Committee region Arnhem-Nijmegen. The results of this trial will be disseminated in one main paper and in additional papers with subgroup analyses.nnTRIAL REGISTRATION NUMBER: Netherlands Trial Register (NL7148).},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
INTRODUCTION: Because of the lack of prehospital protocols to rule out a non-ST-segment elevation acute coronary syndrome (NSTE-ACS), patients with chest pain are often transferred to the emergency department (ED) for thorough evaluation. However, in low-risk patients, an ACS is rarely found, resulting in unnecessary healthcare consumption. Using the HEART (History, ECG, Age, Risk factors and Troponin) score, low-risk patients are easily identified. When a point-of-care (POC) troponin measurement is included in the HEART score, an ACS can adequately be ruled out in low-risk patients in the prehospital setting. However, it remains unclear whether a prehospital rule-out strategy using the HEART score and a POC troponin measurement in patients with suspected NSTE-ACS is cost-effective.nnMETHODS AND ANALYSIS: The ARTICA trial is a randomised trial in which the primary objective is to investigate the cost-effectiveness after 30 days of an early rule-out strategy for low-risk patients suspected of a NSTE-ACS, using a modified HEART score including a POC troponin T measurement. Patients are included by ambulance paramedics and 1:1 randomised for (1) presentation at the ED (control group) or (2) POC troponin T measurement (intervention group) and transfer of the care to the general practitioner in case of a low troponin T value. In total, 866 patients will be included. Follow-up will be performed after 30 days, 6 months and 12 months.nnETHICS AND DISSEMINATION: This trial has been accepted by the Medical Research Ethics Committee region Arnhem-Nijmegen. The results of this trial will be disseminated in one main paper and in additional papers with subgroup analyses.nnTRIAL REGISTRATION NUMBER: Netherlands Trial Register (NL7148).
