A prospective cohort study to improve the AccUracy of Referrals to the emerGency departmEnt of patieNts with chesT pain: to decrease the delay in acute coronary syndrome patients and rule out non-cardiac chest pain patients (URGENT)

This study aims to aid the general practitioner (GP) in the diagnostic dilemma
of chest pain patients. Patients with acute coronary syndrome (ACS) should be
referred to the hospital promptly, though referring all patients with chest
pain is not feasible, as up to 80% of the patients with chest pain in the
primary care do not have ACS.

The primary objective is to refer patients who contact the out-of-hours GP
cooperation (GPC) with suspicion of ACS more accurately.

The secondary objectives are:
1. A registry of all patients referred to the emergency department (ED) with
suspected ACS to assess the appropriateness of referrals, either by EMT, GP or
as self-referrals. This will be compared to the baseline registry performed
from the 1st of September 2015 until the 1st of March 2016. We will include all
patients referred to the hospital, to not miss any patients who have contacted
the GPC and have been referred promptly to the ED.
2. A comparison of patient characteristics, signs and symptoms to the baseline
registry to evaluate the clinical differences between ACS and NCCP patients.
3. A comparison of patients referred promptly after nurse phone triage at the
GPC at baseline (before intervention) and after intervention.
4. A comparison of patients referred to the ED after evaluation by the GP with
the Heart score including ECG and troponin, compared to referral at baseline
without these tests.
5. Analytical comparison of point of care tester troponin tester versus high
sensitive troponin-I (hsT-I) at second evaluation with blood test.
6. The mortality and major adverse cardiovascular events (MACE) at 30 days, 6
months and 1 year.

This study is a prospective, observational, prevalence-based cohort study
within the standard care of ACS patients.

Patients enrolled within this study will receive a fingerstick blood test and
ECG recording at the GPC and for follow-up purposes a fingerstick blood test
and a venous blood test at least four hours after first blood test (and up to
24 hours after). We may follow-up within a year if we can not obtain the
required information from medical records. We expect no adverse events and
there are no expected risks associated with this protocol. We expect patients
with ACS to be referred more accurately and more promptly to the ED and thus
lowering risks.