Validation of the HAR Score for Prioritization of Patients Calling the Emergency Medical Service for Chest Pain by Emergency Call Dispatcher

NCT06859021 | Not Yet Recruiting

• 1 other identifier: CHM-2024-S01-08
• Study Type: observational
• Target: 796
• Locations: 1 country
• Sites: 3

Brief Summary

The lifetime prevalence of chest pain in the general population is 20-40%. The etiologies to be evoked from the outset of management are those of cardiovascular origin, such as acute coronary syndrome (ACS) and pulmonary embolism. ACS is responsible for almost 20% of deaths. Delay in treatment is a major prognostic factor, given the importance of coronary reperfusion. In France, one of the first contacts with the healthcare system is the medical regulation assistant (MRA) at the Centre 15. His or her role is to prioritize the call according to the identification of immediate signs of seriousness, and if necessary, to decide autonomously to send a rescue team before medical regulation. Depending on the reason for the call and any signs of seriousness, it prioritizes the call according to the expected response time. In line with current recommendations, all calls for chest pain should be answered by an emergency medical dispatcher (EMR) within 5 minutes. However, 60-90% of chest pain calls are not of cardiovascular origin. Their prioritization could therefore be re-qualified for longer response times. Given the frequency of this type of call, a more efficient MRA referral strategy is needed. To achieve this, decision-support tools would be essential. The performance of the HAR (History, Age and Risk Factors) score has been recently explored, derived from the HEART score, in a previous single-center prospective study in 2019. It stratifies the risk of a major cardiovascular event (MCE) into low (0 or 1 point), intermediate (2 or 3 points) or high (4, 5 or 6 points). Investigator's hypothesis is that the HAR score could be entrusted to MRA, to enable them to optimize the prioritization of patients calling with non-traumatic chest pain, by qualifying low-risk chest pain calls on the one hand, which could be prioritized in P2 SNP, and high-risk calls on the other, making it possible to anticipate the dispatch of an emergency service.

Conditions

Chest Pain

Keywords

Chestpain; HAR score; Emergency call

Outcome Measures

Primary Outcomes (1)

• Number of major cardiovascular events

  Number of major cardiovascular events is measured by presence of Death from cardiological causes, Type 1 or 2 myocardial infarction, Percutaneous coronary intervention, Surgical coronary bypass surgery

  30 days

Secondary Outcomes (4)

• Performance of the HAR Score: Sensitivity, Specificity, and Comparison Between EMR and MRA

  From Day 0 to Day 30

• Comparaison between rescue resources decided and predicted by the HAR score

  From Day 0 to Day 30

• Time delta between the end of the MRA's score suggesting the dispatch of equipment (HAR score ≥ 4 points) and the actual decision to dispatch equipment in the current situation.

  From Day 0 to Day 30

• Area under the ROC curve and Delong-Delong test

  From Day 0 to Day 30

Study Arms (1)

call for chest pain

patients who call for chest pain

Other: follow up call

Interventions

follow up call OTHER

A follow-up call is made to the patient 30 days (+ 5 days) after inclusion to check for the occurrence of an Major Cardio Vascular Event.

call for chest pain

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

Patients calling center 15 for chest pain

You may qualify if:

• Patient of legal age (≥ 18 years)
• Calling Center 15 from 49, 72 or 37
• Expressing non-traumatic chest pain, even if this is not the main reason for seeking help.

You may not qualify if:

• Treatment in departments other than 49, 72 and 37
• Taken in charge in an emergency department of a private facility in the 49, 72 and 37 départements
• Poor understanding of the French language
• Non-affiliated or non-beneficiary of a social security scheme
• Person deprived of liberty by judicial or administrative decision
• Person under forced psychiatric care
• Person subject to a legal protection measure
• Person unable to express his/her non-opposition.
• Follow-up at Day 30 impossible for any reason
• Person having expressed his/her opposition to the collection of his/her data.

Sponsors & Collaborators

• Centre Hospitalier le Mans: lead

Study Sites (3)

Centre Hospitalier Universitaire d'Angers

Angers, 49000, France

Location

Centre Hospitalier Le Mans

Le Mans, 72000, France

Location

CHRU de Tours

Tours, 37000, France

Location

MeSH Terms

Conditions

Chest Pain

Condition Hierarchy (Ancestors)

Pain; Neurologic Manifestations; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Central Study Contacts

Christelle JADEAU

CONTACT

+33244710781; cjadeau@ch-lemans.fr

Cyrielle HOUALARD, MD

CONTACT

+33243434343; choualard@ch-lemans.fr

Study Design

• Study Type: observational
• Observational Model: OTHER
• Time Perspective: PROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: February 28, 2025
• First Posted: March 5, 2025
• Study Start: May 2, 2025
• Primary Completion: December 1, 2025
• Study Completion: December 1, 2025
• Last Updated: March 24, 2025

Record last verified: 2025-03

Locations

FR (3)