Evaluation of the Marburg Heart Score and INTERCHEST score compared to current telephone triage for chest pain in out-of-hours primary care

Introduction Chest pain is a common and challenging symptom for telephone triage in urgent primary care. Existing chest-pain-specific risk scores originally developed for diagnostic purposes may outperform current telephone triage protocols. Methods This study involved a retrospective, observational...

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Bibliographic Details
Published in:Netherlands heart journal 2023-04, Vol.31 (4), p.157-165
Main Authors: Manten, A., De Clercq, L., Rietveld, R. P., Lucassen, W. A. M., Moll van Charante, E. P., Harskamp, R. E.
Format: Article
Language:English
Subjects:
Acute coronary syndromes
Cardiology
Cardiovascular disease
Clinical outcomes
Coronary vessels
Medical Education
Medical referrals
Medicine
Medicine & Public Health
Original
Original Article
Pain
Patients
Performance evaluation
Primary care
Software
Telemedicine
Transient ischemic attack
Vein & artery diseases
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Summary:Introduction Chest pain is a common and challenging symptom for telephone triage in urgent primary care. Existing chest-pain-specific risk scores originally developed for diagnostic purposes may outperform current telephone triage protocols. Methods This study involved a retrospective, observational cohort of consecutive patients evaluated for chest pain at a large-scale out-of-hours primary care facility in the Netherlands. We evaluated the performance of the Marburg Heart Score (MHS) and INTERCHEST score as stand-alone triage tools and compared them with the current decision support tool, the Netherlands Triage Standard (NTS). The outcomes of interest were: C‑statistics, calibration and diagnostic accuracy for optimised thresholds with major events as the reference standard. Major events are a composite of all-cause mortality and both cardiovascular and non-cardiovascular urgent underlying conditions occurring within 6 weeks of initial contact. Results We included 1433 patients, 57.6% women, with a median age of 55.0 years. Major events occurred in 16.4% ( n  = 235), of which acute coronary syndrome accounted for 6.8% ( n  = 98). For predicting major events, C‑statistics for the MHS and INTERCHEST score were 0.74 (95% confidence interval: 0.70–0.77) and 0.76 (0.73–0.80), respectively. In comparison, the NTS had a C-statistic of 0.66 (0.62–0.69). All had appropriate calibration. Both scores (at threshold ≥ 2) reduced the number of referrals (with lower false-positive rates) and maintained equal safety compared with the NTS. Conclusion Diagnostic risk stratification scores for chest pain may also improve telephone triage for major events in out-of-hours primary care, by reducing the number of unnecessary referrals without compromising triage safety. Further validation is warranted.
ISSN:1568-5888
1876-6250
DOI:10.1007/s12471-022-01745-0