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. By drafting this triage method, we specifically aimed to safely reduce unnecessary ED visits of patients with all types of cardiac complaints. In addition, we intend to provide patient-tailored care through prehospital assessment of patient-specific needs and circumstances. 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. The HART-c study is a multicentre prospective study with a historical control group. 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 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). 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. 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. Intervention group: prehospital triage using HART-c method Box 1 displays the detailed inclusion and exclusion criteria. 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. 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.
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