{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:04:22Z","timestamp":1792785862265,"version":"4.5.0"},"reference-count":39,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2021,11,25]],"date-time":"2021-11-25T00:00:00Z","timestamp":1637798400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Isala Research Fun","award":["INNO1326"],"award-info":[{"award-number":["INNO1326"]}]},{"name":"Roche Diagnostics provided POC devices and POC strips"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,2,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Although pre-hospital risk stratification of patients with suspected non-ST-elevation acute coronary syndrome (NSTE-ACS) by ambulance paramedics is feasible, it has not been investigated in daily practice whether referral decisions based on this risk stratification is safe and does not increase major adverse cardiac events (MACE). In Phase III of the FamouS Triage study, it was investigated whether referral decisions by ambulance paramedics based on a pre-hospital HEART score, is non-inferior to routine management.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>FamouS Triage Phase III is a non-inferiority study, comparing the occurrence of MACE before (Phase II) and after (Phase III) implementation of referral decisions based on a pre-hospital HEART score. In Phase II, all patients were risk-stratified and referred to the hospital; in Phase III, low-risk patients (HEART score \u2264 3) were not referred. Primary endpoint was MACE (acute coronary syndrome, revascularization, or death) within 45\u2009days. A total of 1236 patients were included. Mean age was 63\u2009years, 43% were female, 700 patients were included in the second phase and 536 in the third phase in which 149 low-risk patients (28%) were not transferred to the hospital. Occurrence of 45\u2009days MACE was 16.6% in Phase II and 15.7% in Phase III (P\u2009=\u20090.67). Percentage MACE in low-risk patients was 2.9% in Phase II and 1.3% in Phase III. After adjustments for differences in baseline variables, the hazard ratio of 45\u2009days MACE in Phase III was 0.88 (95% confidence interval 0.63\u20131.25) as compared to Phase II.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Pre-hospital risk stratification of patients with suspected NSTE-ACS, avoiding hospitalization of a substantial number of low-risk patients, seems feasible and non-inferior to transferring all patients to the hospital.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjacc\/zuab109","type":"journal-article","created":{"date-parts":[[2021,11,5]],"date-time":"2021-11-05T08:23:43Z","timestamp":1636100623000},"page":"160-169","source":"Crossref","is-referenced-by-count":25,"title":["Referral decisions based on a pre-hospital HEART score in suspected non-ST-elevation acute coronary syndrome: final results of the FamouS Triage study"],"prefix":"10.1093","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5255-8645","authenticated-orcid":false,"given":"Rudolf T","family":"Tolsma","sequence":"first","affiliation":[{"name":"Emergency Medical Service, Ambulance IJsselland, Voltastraat 3A, 8013 PM Zwolle, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4687-1157","authenticated-orcid":false,"given":"Marion J","family":"Fokkert","sequence":"additional","affiliation":[{"name":"Department of Clinical Chemistry, Isala Hospital, Dokter van Heesweg 2, 8025 AB Zwolle, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8630-080X","authenticated-orcid":false,"given":"Dominique N","family":"van Dongen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Isala Hospital, Dokter van Heesweg 2, 8025 AB Zwolle, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1777-1779","authenticated-orcid":false,"given":"Erik A","family":"Badings","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Deventer Hospital, Nico Bolkesteinlaan 75, 7416 SE Deventer, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aize","family":"van der Sluis","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Deventer Hospital, Nico Bolkesteinlaan 75, 7416 SE Deventer, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8583-376X","authenticated-orcid":false,"given":"Robbert J","family":"Slingerland","sequence":"additional","affiliation":[{"name":"Department of Clinical Chemistry, Isala Hospital, Dokter van Heesweg 2, 8025 AB Zwolle, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esther","family":"van \u2019t Riet","sequence":"additional","affiliation":[{"name":"Department of Research, UMCU, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6647-8574","authenticated-orcid":false,"given":"Jan Paul","family":"Ottervanger","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Isala Hospital, Dokter van Heesweg 2, 8025 AB Zwolle, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2344-7564","authenticated-orcid":false,"given":"Arnoud W J","family":"van \u2019t Hof","sequence":"additional","affiliation":[{"name":"Department of Cardiology, MUMC, P. 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