The ARTICA (“Acute Rule out of non ST-segment elevation acute coronary syndrome in the (pre)hospital setting”) trial is being conducted at Radboud UMC in Nijmegen, the Netherlands. Dr. Cyril Camaro and his team started this randomized, 2-arm trial in March 2019 and plan to finish March 2022. The objective of the ARTICA trial is to assess cost-effectiveness and efficacy of ambulance triage of patients with low risk non-ST elevation acute coronary syndrome (ACS).
Currently, all patients suspected of non ST-segment elevation acute coronary syndrome (NSTE-ACS) are evaluated in hospital emergency departments. In patients at low risk for ACS, NSTE-ACS is in fact, rarely found. If these patients could be effectively managed outside of hospital (ie. by their family physician), it could decrease health care costs, and lessen overcrowding in the ER.
The HEART (History, ECG, Age, Risk Factors, & Troponin) scoring system is a tool that is based on expert opinion. It has been validated in emergency departments throughout the world. The HEART score is used to prognosticate patients according to their risk of suffering a Major Adverse Cardiac Event (MACE) within 6 weeks. For patients ≥ 18 years old who have had chest pain for ≥ 2 hours, paramedics will determine their HEAR score. If it is ≤ 3, the patient will be randomized to either be evaluated at hospital, or to have their troponin (T) score derived by a (POC) troponin device. Next, if T <40, the patient will be referred for follow-up to their Family Physician. If T ≥ 40, patients will be referred to hospital for management.
Primary Endpoint: Camaro and his team anticipate a dramatic decrease in health care costs by 30 days. These savings are expected to be reflected in health care resources and ambulance use. The team project potential savings of €40 billion.
Secondary Endpoint: Follow-up will be performed 1, 6 and 12 months later to ask about interim health care utilization. It is expected that at 12 months, this strategy will correlate with a very low MACE rate.
Stay Tuned! Dr. Camaro and his team began this trial in 2019 and are projecting an end date of 2022. They are hoping to enroll 866 patients in the trial. They are currently working with only one ambulance region in the south of the Netherlands. Their goal is to expand to a larger region so that they will be able to have more inclusions in a shorter period.
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Author: Kelly Schoonderwoerd