cardiac monitor that contiusly monity st elevation

In line with the National Protocol for Emergency Medical Care, patients at first receive standard medical care consisting of a medical history, physical examination with vital sign monitoring (blood pressure, heart rate and pulse oximetry) and a 12-lead ECG. The intervention group consists of patients visited by the EMS because of symptoms suspected to be of cardiac origin, such as chest pain, shortness of breath, palpitations or implanted cardiac device problems. Intervention group: prehospital triage using HART-c method Box 1 displays the detailed inclusion and exclusion criteria. Patients in need of urgent cardiac care, patients with complaints not suspected of cardiac origin as assessed by the ambulance paramedic and patients unable or not willing to provide informed consent were excluded from triage according to the HART-c method. Of note, in both groups, EMS consultation could have been requested directly by the patient, through bystanders or by the patients’ general practitioner (GP), who refers patients through EMS. The historical control groups consist of adult patients visited by the regional EMS because of cardiac complaints between 1 September 2018 and 31 August 2019 (1 year before the start of the HART-c triage method). The intervention group comprises adult patients visited by the regional emergency medical services (EMS) because of cardiac complaints between 1 September 2019 and 31 August 2020 in whom prehospital triage is performed according to the HART-c triage method.

The HART-c study is a multicentre prospective study with a historical control group. The HART-c study was designed to evaluate whether the implementation of the HART-c triage method results in a reduction of unnecessary ED visits. In addition, we intend to provide patient-tailored care through prehospital assessment of patient-specific needs and circumstances. By drafting this triage method, we specifically aimed to safely reduce unnecessary ED visits of patients with all types of cardiac complaints. Innovative in this approach is the combination of prehospital patient assessment by the ambulance paramedic and expert consultation of a cardiologist who has access to live-monitored data from the ambulance, in-hospital data and real-time hospital admission capacity in a newly developed triage application. 12 In order to improve prehospital triage for patients with cardiac complaints in the entire chain of acute cardiac care, we developed a comprehensive triage method entitled Hollands-Midden Acute Regional Triage-Cardiology (HART-c). Efforts to prevent ED visits especially involve interventions focused on patients with chest pain, such as risk score calculation by the ambulance paramedics (eg, with the HEART score 10 and History and Electrocardiogram-Only Manchester Acute Coronary Syndrome (HE-MACS) 11 or prehospital point of care testing for troponin. Preventing patients with cardiac complaints and a very low risk of adverse cardiac events from visiting the ED will substantially help to reduce ED overcrowding. 9 However, as it takes 1–2 hours for the latter to be available, patients still spend a long time at the ED, after which the majority can be discharged home.Īccordingly, interest has shifted from in-hospital to prehospital triage.

For example, the HEART (History, ECG, Age, Risk Factors, Troponin) score stratifies patients as at low, intermediate or high risk of major adverse cardiac events (MACEs) based on history, the ECG, age, risk factors and troponin levels. 5–8 However, these patients contribute to overcrowding of EDs and these ED visits substantially increase healthcare costs.Īttempts to reduce ED overcrowding by patients with cardiac complaints have so far particularly focused on rapid risk stratification after presentation at the ED. 4 The majority will be sent home after ruling out acute cardiovascular disease: previous studies have shown that up to 80% of patients with chest pain do not have an acute coronary syndrome. 3 In Europe and the USA, 15–20 million patients with chest pain are seen at the ED every year. 1 2 Cardiac complaints are one of the most common reasons for patients to visit the ED, with chest pain as the most frequent complaint. Emergency department (ED) overcrowding is a worldwide healthcare problem associated with worse patient outcomes and increased costs.

Cardiac monitor that contiusly monity st elevation