Study: New approach helps EMS providers better determine cardiac event risks

Researchers evaluated the use of a pre-hospital modified HEART Pathway method for patients who call 911 due to chest pain


By Laura French

WINSTON-SALEM, N.C. — North Carolina researchers have evaluated the use of a new method to determine cardiac event risks in a prehospital setting. 

A study conducted at Wake Forest Baptist Health showed that on-scene use of a new pre-hospital modified HEART Pathway protocol helped EMS providers better assess cardiac event risks for patients complaining of chest pain, according to a news release. The method can help providers determine which hospital a patient should be transported to where they can receive the care best suited for their risk level. 

Dr. Jason Stopyra (far left) demonstrates using an i-STAT device with paramedics Callie Katers (second from right) and Bubba Killgo (far right), with Wake Forest Baptist employee Rebecca Overman standing in as a patient.
Dr. Jason Stopyra (far left) demonstrates using an i-STAT device with paramedics Callie Katers (second from right) and Bubba Killgo (far right), with Wake Forest Baptist employee Rebecca Overman standing in as a patient. (Photo/Wake Forest Baptist Health)

"While only 7% of people who make 911 calls due to chest pain are having a heart attack, paramedics must be able to make the correct decisions using objective measurements to identify another 20% that need specific cardiac care," said Jason Stopyra, MD, an associate professor of emergency medicine at Wake Forest Baptist and principal investigator of the study, in statement. "High-risk patients are often transported to facilities that don't have interventional cardiology capabilities, and later have to be transferred to another hospital for urgent procedures." 

The study was published in the Oct. 7 edition of the journal PLOS One. The protocol used is a version of the HEART Pathway decision aid developed by Simon Mahler, MD, professor of emergency medicine at Wake Forest Baptist, who was also a senior author on the study. The original HEART Pathway method has been used in emergency departments for about eight years and was adapted for prehospital use in the study. 

The protocol involves using a hand-held i-STAT device that measures patients' blood for levels of troponin, a cardiac enzyme that can help detect heart injury. Based on these troponin levels and the patient's HEART risk score, based on pain, age, medical history and other risk factors, providers can determine whether the patient is at high risk (elevated troponin), moderate risk (negative troponin and HEART score of 4 or higher), or low risk (negative troponin and HEART score lower than 4).

The study involved training more than 150 North Carolina paramedics to use the method and found that application of the method achieved high sensitivity, specificity and negative predictive value for major adverse cardiac events within 30 days after transport. 

"This teamwork between emergency medicine researchers and our local EMS agencies is so valuable, Stropyra stated. "Our study showed that paramedics have the professional clinical ability to effectively assess patients' cardiac risk using this protocol before the patient ever gets to the hospital. We hope this approach will allow patients to receive faster, more focused care." 

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