Ambulance troponin testing may keep more chest pain patients out of the ED

Clinical takeaway: Prehospital high-sensitivity point-of-care troponin testing combined with the HEART score may help ambulance teams identify low-risk chest pain patients who can avoid hospital transport. These preliminary findings should not change practice outside validated protocols with clinical oversight and clear safety-net instructions.

About 95% of patients assessed by ambulance crews for chest pain are transported to a hospital, although only a minority have a serious condition. Risk stratification at the scene could spare unnecessary ED visits and ease crowding.

In this Dutch before-after study, the Rotterdam-Rijnmond ambulance service enrolled 1,022 patients from 2022 to 2025. Usual assessment guided transport for 539 patients; after implementation, 483 received usual assessment plus the QuidelOrtho TriageTrue high-sensitivity troponin test, with results incorporated into the HEART score.

Patients could remain home or be referred to primary care only if their HEART score was low, troponin was below 4 ng/L and crews suspected no other serious condition. The proportion left at home rose from 19 patients (3.5%) before implementation to 165 (34.2%) afterward—an absolute increase of 30.7 percentage points and nearly a 10-fold rise.

In an updated preliminary analysis with 86% follow-up complete, 30-day major adverse cardiovascular events occurred in 15.0% of patients before implementation and 9.8% afterward, a 35% relative decrease that cannot establish causation. Among the 165 patients left home after implementation, 1 (0.6%) had an event within 30 days; none of the 19 left home previously did.

The study was nonrandomized, follow-up was incomplete and the postimplementation group included more low-risk patients, although adjustment did not materially alter results. The findings were presented at the European Emergency Medicine Congress (EUSEM) 2026 and have not yet been peer reviewed.

“Hospital referrals were reduced significantly. This is good for patients and good for hospitals,” said study author Dr Barbra Backus.

Source: van der Waarden N, et al. Implementation of High Sensitive Point of Care Troponin in the Prehospital Setting, a Before-after Trial, Preliminary Results. Presented at: EUSEM Congress 2026.