Could a risk score keep chest pain patients safely at home? A large randomized trial out of the Netherlands suggests yes. The PreHEART score — which factors in symptom history, ECG findings, age, sex-specific cardiovascular risk, and a bedside troponin test — guided EMS teams on whether to transport chest pain patients to the hospital. The result: it was just as safe as standard care, with no increase in serious adverse events over 3 days or up to 12 months.

The real win was in efficiency. Patients in the PreHEART group were 41% more likely to avoid hospital transport at first contact, 12% less likely to visit an ED within 30 days, and had meaningfully lower healthcare costs. Notably, no patient who was not transported died within 3 days in either group.

By the Numbers:

• 5,170 adults enrolled across the Netherlands (March 2021–April 2022)
• 41% more likely to avoid hospital transport in the PreHEART group
• €345 mean per-patient cost savings at 30 days
• ~€52 million in estimated annual savings if applied nationwide
• Women in the PreHEART group were 48% more likely to be diagnosed with ACS

Why it matters: Chest pain is one of the most common EMS calls, and unnecessary hospital transports strain emergency systems. A validated, easy-to-use prehospital score that safely reduces low-risk transports could ease ER overcrowding and cut costs — without compromising patient safety.