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1.
J Sleep Res ; 31(6): e13591, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-2137087

ABSTRACT

This study examined the role of sleep disturbances and insomnia in the context of stress reactivity in adolescence. One-hundred and thirty-five 11-18 year olds (Mage  = 14.2 years, SD = 1.9, 52% female) completed the Trier Social Stress Test for Children. Salivary cortisol and subjective stress ratings were collected at six time points, and heart rate as well as heart rate variability were measured pre-, during and post-stress induction. Additionally, sleep disturbances and insomnia diagnosis were assessed by a self-report questionnaire and a sleep interview. Robust mixed models investigated if adolescents with compared with adolescents without (a) sleep disturbances and (b) insomnia differ regarding cortisol, heart rate, heart rate variability and psychological stress reactivity considering gender effects. The results indicated that boys with high sleep disturbances showed higher cortisol activity compared with boys with low sleep disturbances, B = 0.88, p < 0.05. Moreover, in boys with insomnia, heart rate and alpha 1 significantly differ less than in boys without insomnia. These findings support the notion of sex differences regarding the association between poor sleep and increased activity of the hypothalamic-pituitary-adrenal axis, and a less adaptable autonomic nervous system in boys in response to an experimental social stress task.


Subject(s)
Sleep Initiation and Maintenance Disorders , Sleep Wake Disorders , Child , Female , Adolescent , Humans , Male , Hydrocortisone , Hypothalamo-Hypophyseal System , Pituitary-Adrenal System , Sleep/physiology , Stress, Psychological/complications , Electrocardiography , Saliva
2.
Contrast Media Mol Imaging ; 2022: 7580008, 2022.
Article in English | MEDLINE | ID: covidwho-2121661

ABSTRACT

Acquired Immune Deficiency Syndrome (AIDS) is a fatal infectious disease caused by human immunodeficiency virus, which poses a serious threat to human health. The contagion of AIDS has greatly increased the psychological pressure of frontline medical staff. The mental health service behavior of medical staff based on electrocardiograms is analyzed. Firstly, an automatic ECG analysis technique is employed to evaluate the mental health service behavior of medical staff. Then, in order to promote the relationship between doctors and patients, Holter's algorithm is applied to improve mental health services. Subsequently, the experiment based on ECG data is conducted to solve the problem of relieving the psychological pressure of medical staff. All samples are divided into high group (average score is 29.21), average group (average score is 31.43), and low group (average score is 34.85) according to the first 20%, middle 60%, and last 20%. The experimental results show that a considerable number of frontline medical personnel have psychological problems in AIDS surgery.


Subject(s)
Acquired Immunodeficiency Syndrome , Mental Health Services , Electrocardiography , Humans , Medical Staff
3.
PLoS One ; 17(11): e0277081, 2022.
Article in English | MEDLINE | ID: covidwho-2109327

ABSTRACT

The COVID-19 pandemic has exposed the vulnerability of healthcare services worldwide, raising the need to develop novel tools to provide rapid and cost-effective screening and diagnosis. Clinical reports indicated that COVID-19 infection may cause cardiac injury, and electrocardiograms (ECG) may serve as a diagnostic biomarker for COVID-19. This study aims to utilize ECG signals to detect COVID-19 automatically. We propose a novel method to extract ECG signals from ECG paper records, which are then fed into one-dimensional convolution neural network (1D-CNN) to learn and diagnose the disease. To evaluate the quality of digitized signals, R peaks in the paper-based ECG images are labeled. Afterward, RR intervals calculated from each image are compared to RR intervals of the corresponding digitized signal. Experiments on the COVID-19 ECG images dataset demonstrate that the proposed digitization method is able to capture correctly the original signals, with a mean absolute error of 28.11 ms. The 1D-CNN model (SEResNet18), which is trained on the digitized ECG signals, allows to identify between individuals with COVID-19 and other subjects accurately, with classification accuracies of 98.42% and 98.50% for classifying COVID-19 vs. Normal and COVID-19 vs. other classes, respectively. Furthermore, the proposed method also achieves a high-level of performance for the multi-classification task. Our findings indicate that a deep learning system trained on digitized ECG signals can serve as a potential tool for diagnosing COVID-19.


Subject(s)
COVID-19 , Humans , COVID-19/diagnosis , Signal Processing, Computer-Assisted , Pandemics , Algorithms , Neural Networks, Computer , Electrocardiography
4.
J Korean Med Sci ; 37(42): e306, 2022 Oct 31.
Article in English | MEDLINE | ID: covidwho-2099100

ABSTRACT

A 43-year-old man presented with cardiac arrest 2 days after the second coronavirus disease 2019 (COVID-19) vaccination with an mRNA vaccine. Electrocardiograms showed ventricular fibrillation and type 1 Brugada pattern ST segment elevation. The patient reported having no symptoms, including febrile sensation. There were no known underlying cardiac diseases to explain such electrocardiographic abnormalities. ST segment elevation completely disappeared in two weeks. Although there were no genetic mutations or personal or family history typical of Brugada syndrome, flecainide administration induced type 1 Brugada pattern ST segment elevation. This case suggests that COVID-19 vaccination may induce cardiac ion channel dysfunction and cause life threatening ventricular arrhythmias in specific patients with Brugada syndrome.


Subject(s)
Brugada Syndrome , COVID-19 , Male , Humans , Adult , Brugada Syndrome/diagnosis , Brugada Syndrome/etiology , Ventricular Fibrillation/diagnosis , Ventricular Fibrillation/etiology , COVID-19 Vaccines/adverse effects , Electrocardiography/adverse effects , Vaccination/adverse effects
5.
Scand J Trauma Resusc Emerg Med ; 29(1): 145, 2021 Oct 03.
Article in English | MEDLINE | ID: covidwho-2098399

ABSTRACT

BACKGROUND: Sepsis is a life-threatening organ dysfunction and a major healthcare burden worldwide. Although sepsis is a medical emergency that requires immediate management, screening for the occurrence of sepsis is difficult. Herein, we propose a deep learning-based model (DLM) for screening sepsis using electrocardiography (ECG). METHODS: This retrospective cohort study included 46,017 patients who were admitted to two hospitals. A total of 1,548 and 639 patients had sepsis and septic shock, respectively. The DLM was developed using 73,727 ECGs from 18,142 patients, and internal validation was conducted using 7774 ECGs from 7,774 patients. Furthermore, we conducted an external validation with 20,101 ECGs from 20,101 patients from another hospital to verify the applicability of the DLM across centers. RESULTS: During the internal and external validations, the area under the receiver operating characteristic curve (AUC) of the DLM using 12-lead ECG was 0.901 (95% confidence interval, 0.882-0.920) and 0.863 (0.846-0.879), respectively, for screening sepsis and 0.906 (95% confidence interval (CI), 0.877-0.936) and 0.899 (95% CI, 0.872-0.925), respectively, for detecting septic shock. The AUC of the DLM for detecting sepsis using 6-lead and single-lead ECGs was 0.845-0.882. A sensitivity map revealed that the QRS complex and T waves were associated with sepsis. Subgroup analysis was conducted using ECGs from 4,609 patients who were admitted with an infectious disease, and the AUC of the DLM for predicting in-hospital mortality was 0.817 (0.793-0.840). There was a significant difference in the prediction score of DLM using ECG according to the presence of infection in the validation dataset (0.277 vs. 0.574, p < 0.001), including severe acute respiratory syndrome coronavirus 2 (0.260 vs. 0.725, p = 0.018). CONCLUSIONS: The DLM delivered reasonable performance for sepsis screening using 12-, 6-, and single-lead ECGs. The results suggest that sepsis can be screened using not only conventional ECG devices but also diverse life-type ECG machines employing the DLM, thereby preventing irreversible disease progression and mortality.


Subject(s)
COVID-19 , Deep Learning , Sepsis , Electrocardiography , Humans , Retrospective Studies , SARS-CoV-2 , Sepsis/diagnosis
6.
Int J Environ Res Public Health ; 19(20)2022 Oct 20.
Article in English | MEDLINE | ID: covidwho-2081837

ABSTRACT

Individuals affected by COVID-19 have an alteration in autonomic balance, associated with impaired cardiac parasympathetic modulation and, consequently, a decrease in heart rate variability (HRV). This study examines the inter- and intrarater reliability of HRV) parameters derived from short-term recordings in individuals post-COVID. Sixty-nine participants of both genders post-COVID were included. The RR interval, the time elapsed between two successive R-waves of the QRS signal on the electrocardiogram (RRi), were recorded during a 10 min period in a supine position using a portable heart rate monitor (Polar® V800 model). The data were transferred into Kubios® HRV standard analysis software and analyzed within the stable sessions containing 256 sequential RRi. The intraclass correlation coefficient (ICC) ranged from 0.920 to 1.000 according to the intrarater analysis by Researcher 01 and 0.959 to 0.999 according to the intrarater by Researcher 02. The interrater ICC ranged from 0.912 to 0.998. The coefficient of variation was up to 9.23 for Researcher 01 intrarater analysis, 6.96 for Researcher 02 intrarater analysis and 8.83 for interrater analysis. The measurement of HRV in post-COVID-19 individuals is reliable and presents a small amount of error inherent to the method, supporting its use in the clinical environment and in scientific research.


Subject(s)
COVID-19 , Humans , Female , Male , Heart Rate/physiology , Reproducibility of Results , Electrocardiography/methods , Autonomic Nervous System
7.
Eur Rev Med Pharmacol Sci ; 26(18): 6879-6884, 2022 Sep.
Article in English | MEDLINE | ID: covidwho-2056908

ABSTRACT

OBJECTIVE: COVID-19 infection is known to injure myocardial tissue and increase arrhythmic events. However, data on the subject is limited in the literature. In our study, our aim was to investigate possible arrhythmic damages in COVID-19 survivors using the frontal plane QRS-T [f(QRS)-T] angle and a few other ECG parameters. PATIENTS AND METHODS: 269 patients who recovered from COVID-19 between April 2020 and January 2021 were included into the study. Pre-admission electrocardiograms and first-month outpatient clinic control ECGs of the patients were compared. RESULTS: After COVID-19, left bundle branch block (p<0.001), right bundle branch block (p<0.001), right bundle branch block (p<0.001), and atrial fibrillation (p<0.001) rates had increased. Prolongation was detected in QRS duration (p<0.001), QT interval (p=0.014), adjusted QT interval (p=0.007) and Tpe interval (p=0.012). F(QRS)-T angle (p<0.001) and fragmented QRS rate (p<0.001) were increased. CONCLUSIONS: It was observed in our study that even if patients survived COVID-19, permanent deterioration in ECG parameters may occur.


Subject(s)
Arrhythmias, Cardiac , Bundle-Branch Block , COVID-19 , Arrhythmias, Cardiac/diagnosis , Electrocardiography , Humans , Survivors
9.
J Cardiovasc Pharmacol ; 80(4): 616-622, 2022 10 01.
Article in English | MEDLINE | ID: covidwho-2051608

ABSTRACT

ABSTRACT: Bradycardia and QTc interval prolongation on the ECG have been reported with remdesivir (Veklury), an antiviral drug recently approved for treating severely ill patients with COVID-19. The objective was to evaluate the effects of remdesivir on cardiac electrophysiology ex vivo and in vivo. Ex vivo: Langendorff retroperfusion experiments were performed on isolated hearts from male Hartley guinea pigs (n = 23, total) exposed to either remdesivir 3, 10, or 30 µmol/L to assess drug-induced prolongation of the monophasic action potential duration measured at 90% repolarization (MAPD 90 ). In vivo: ECG recordings using wireless cardiac telemetry were performed in guinea pigs (n = 6) treated with daily i.p. doses of remdesivir 5 mg/kg on day 1 and 2.5 mg/kg on days 2-10. Ex vivo remdesivir (3, 10, and 30 µmol/L) had no statistically significant effect on MAPD 90 , while pacing the hearts at basic stimulation cycle lengths of 200 or 250 milliseconds, or when the hearts were not paced and beating at their intrinsic heart rate. In a second set of similar ex vivo experiments, remdesivir 10 µmol/L did not potentiate the MAPD 90 -prolonging effects of dofetilide 20 nmol/L (n = 4) hearts. In vivo remdesivir caused small but statistically significant prolongations of the RR and QTc F intervals at day 1 (5 mg/kg) and at day 10 (2.5 mg/kg). No ventricular arrhythmias were ever observed under the effect of remdesivir. Remdesivir causes bradycardia, and mild QTc prolongation, which nonetheless, could be of clinical relevance in many hospitalized patients with COVID-19 concomitantly treated with multiple drugs.


Subject(s)
COVID-19 , Long QT Syndrome , Action Potentials , Adenosine Monophosphate/analogs & derivatives , Alanine/analogs & derivatives , Animals , Antiviral Agents/adverse effects , Bradycardia/chemically induced , COVID-19/drug therapy , Electrocardiography , Guinea Pigs , Long QT Syndrome/chemically induced , Male
10.
Am J Case Rep ; 23: e937105, 2022 Aug 31.
Article in English | MEDLINE | ID: covidwho-2025553

ABSTRACT

BACKGROUND Guillain-Barre syndrome (GBS) is an autoimmune demyelinating disease that affects peripheral nerves and may be associated with nerve pain in the upper limbs and chest. Autonomic dysfunction in GBS can result in electrocardiography (ECG) changes that include T wave inversion, ST segment depression, or ST segment elevation. Recently, GBS was been recognized as a neurological consequence of COVID-19. This report describes the challenge of emergency diagnosis of posterior myocardial infarction (MI) in a 45-year-old Javanese woman who was known to have a 1-month history of COVID-19-related Guillain-Barre syndrome. CASE REPORT We report the case of a 45-year-old patient who presented to the Emergency Department (ED) with atypical angina. She had a history of GBS that started 2 weeks after she developed COVID-19. Since then, she frequently had pain in both legs and occasionally in the chest. Her electrocardiogram revealed subtle ST segment depression in the anteroseptal leads (V1-V4), along with ST segment elevation in the posterior leads (V7-V9). Cardiac marker (troponin I) was elevated and posterior regional wall motion abnormality was present on an echocardiogram. Coronary angiography revealed total occlusion of the first diagonal branch of the LAD, followed by deployment of drug-eluting stents to achieve good angiographic results. The patient was diagnosed with GBS and isolated posterior ST segment elevation myocardial infarction. CONCLUSIONS This report shows the importance of performing standard cardiac investigations for myocardial ischemia or infarction in patients known to have Guillain-Barre syndrome so that the patient can be treated appropriately and urgently to ensure the best possible outcome.


Subject(s)
COVID-19 , Guillain-Barre Syndrome , Myocardial Infarction , Arrhythmias, Cardiac , COVID-19/complications , COVID-19 Testing , Electrocardiography/methods , Female , Guillain-Barre Syndrome/diagnosis , Guillain-Barre Syndrome/etiology , Humans , Indonesia , Middle Aged , Myocardial Infarction/diagnosis , Myocardial Infarction/etiology
12.
Annu Int Conf IEEE Eng Med Biol Soc ; 2022: 2278-2281, 2022 07.
Article in English | MEDLINE | ID: covidwho-2018743

ABSTRACT

COVID-19 is known to be a cause of microvascular disease due, for example, to the cytokine storm inflammatory response and the result of blood coagulation. This study reports an investigation on Heart Rate Variability (HRV) extracted from photoplethysmography (PPG) signals measured from healthy subjects and COVID-19 affected patients. We aimed to determine a statistical difference between HRV parameters among subjects' groups. Specifically, statistical analysis through Mann-Whitney U Test (MWUT) was applied to compare 42 dif-ferent parameters extracted from PPG signals of 143 subjects: 50 healthy subjects (i.e. group 0) and 93 affected from COVID-19 patients stratified through increasing COVID severity index (i.e. groups 1 and 2). Results showed significant statistical differences between groups in several HRV parameters. In particular, Multiscale Entropy (MSE) analysis provided the master key in patient stratification assessment. In fact, MSE11, MSE12, MSE15, MSE16, MSE17, MSE18, MSE19 and MSE20 keep statistical significant difference during all the comparisons between healthy subjects and patients from all the pathological groups. Our preliminary results suggest that it could be possible to distinguish between healthy and COVID-19 affected subjects based on cardiovascular dynamics. This study opens to future evaluations in using machine learning models for automatic decision-makers to distinguish between healthy and COVID-19 subjects, as well as within COVID-19 severity levels. Clinical Relevance - This establishes the possibility to distin-guish healthy subjects from COVID-19 affected patients basing on HRV parameters monitored non invasively by PPG.


Subject(s)
COVID-19 , Electrocardiography , COVID-19/diagnosis , Electrocardiography/methods , Heart Rate/physiology , Humans , Monitoring, Physiologic/methods , Photoplethysmography/methods
14.
Rev Assoc Med Bras (1992) ; 68(7): 882-887, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-1987228

ABSTRACT

OBJECTIVE: T-wave positivity in the lead aVR is a marker of ventricular repolarization abnormality and provides information on short- and long-term cardiovascular mortality in heart failure patients, those with anterior myocardial infarction, and patients who underwent hemodialysis for various reasons. The aim of this study was to investigate the relationship between T-wave positivity in the lead aVR on superficial electrocardiogram and mortality from COVID-19 pneumonia. METHODS: This study retrospectively included 130 patients who were diagnosed with COVID-19 and treated as an outpatient or in the thoracic diseases ward in a single center between January 2021 and June 2021. All patients included in the study had clinical and radiological features and signs of COVID-19 pneumonia. The COVID-19 diagnosis of all patients was confirmed by polymerase chain reaction detected from an oropharyngeal swab. RESULTS: A total of 130 patients were included in this study. Patients were divided into two groups: survived and deceased. There were 55 patients (mean age: 64.76-14.93 years, 58.18 male, 41.12% female) in the survived group and 75 patients (mean age: 65-15 years, 58.67 male, 41.33% female) in the deceased group. The univariate and multivariate regression analyses showed that positive transcatheter aortic valve replacement (OR 5.151; 95%CI 1.001-26.504; p=0.0012), lactate dehydrogenase (OR 1.006; 95%CI 1.001-1.010; p=0.012), and d-dimer (OR 1.436; 95%CI 1.115-1.848; p=0.005) were independent risk factors for mortality. CONCLUSION: A positive transcatheter aortic valve replacement is useful in risk stratification for mortality from COVID-19 pneumonia.


Subject(s)
Aortic Valve Stenosis , COVID-19 , Heart Valve Prosthesis Implantation , Aortic Valve Stenosis/surgery , COVID-19/diagnosis , COVID-19 Testing , Electrocardiography , Female , Humans , Male , Prognosis , Retrospective Studies , Risk Factors , Treatment Outcome
15.
J Osteopath Med ; 122(10): 503-508, 2022 Oct 01.
Article in English | MEDLINE | ID: covidwho-1987190

ABSTRACT

CONTEXT: During the COVID-19 pandemic, essential in-person electrocardiogram (ECG) recordings became unfeasible, while patients continued to suffer from cardiac conditions. To circumvent these challenges, the cardiology clinic (Long Island Heart Rhythm Center [LIHRC]) at the New York Institute of Technology College of Osteopathic Medicine (NYITCOM) transitioned to a remote real-time outpatient cardiac telemetry (ROCT) service. OBJECTIVES: The goal of this study is to test the hypothesis that at-home ROCT, provided by the LIHRC, is an effective method of providing ECG monitoring to symptomatic patients during the COVID-19 pandemic. METHODS: Seventeen patients at the LIHRC that required ECGs between March 11 and August 1, 2020, were included in this study. The patients' medical records were de-identified and reviewed for age, gender, ROCT indications, findings, patient comfort, and ease of use. A retrospective analysis of observational de-identified data obtained from the LIHRC was approved and permitted by the NYITCOM Institutional Review Board (BHS-1465). These FDA-cleared medical devices (DMS-300, DM Software, Stateline, NV) were shipped to the patients' homes and were self-applied through adhesive chest patches. The devices communicated with a cloud-based system that produced reports including a continuous 6-lead ECG and many other cardiovascular parameters. Additionally, a patient-activated symptom recorder was available to correlate symptoms to ECG findings. RESULTS: Seventeen patients (15 women) from the LIHRC were included in the analysis with an average monitoring duration of 27 h (range, 24-72 h). The patients' ages ranged from 21 to 85 years old with a mean of 37 years old and a standard deviation of 19. ROCT indications included palpitations (n=9), presyncope (n=8), chest pain (n=5), syncope (n=3), and shortness of breath (n=2). One also received ROCT due to short PR intervals observed on a prepandemic ECG. Two patients experienced palpitations while wearing the ROCT device: one had supraventricular tachycardia at 150 beats per minute; the other had unifocal premature ventricular contractions (PVCs) and eventually underwent a successful cardiac ablation. Most patients experienced no symptomatic episodes during ROCT (n=15). The 6-lead ROCT ECG for five of those patients showed arrhythmias including wandering atrial pacemaker (n=2), PVCs (n=2), sinus tachycardia (n=1), premature atrial contractions (PACs) (n=1), ectopic atrial rhythms (n=1), and sinus arrhythmia (n=1). One patient who experienced issues with our device was able to obtain a device from a separate clinic and was found to have bradycardia, PVCs, and nonsustained ventricular tachycardia. Overall, 16/17 (94.1%) patients were monitored effectively with the LIHRC ROCT system, and all (17/17, 100%) patients were monitored effectively with a ROCT system either from the LIHRC or a separate clinic. CONCLUSIONS: With the unique challenges of the COVID-19 pandemic, physicians can use this innovative ROCT method to prevent infection and diagnose cardiac diseases. Most patients and staff were able to utilize the system without issues. Therefore, this system may also be utilized to deliver patient-centered care to those with limited mobility when coupled with a telemedicine visit.


Subject(s)
COVID-19 , Electrocardiography, Ambulatory , Adult , Aged , Aged, 80 and over , Arrhythmias, Cardiac/diagnosis , Arrhythmias, Cardiac/epidemiology , COVID-19/epidemiology , Electrocardiography , Electrocardiography, Ambulatory/methods , Female , Humans , Middle Aged , Outpatients , Pandemics , Retrospective Studies , Telemetry , Young Adult
16.
J Educ Eval Health Prof ; 19: 12, 2022.
Article in English | MEDLINE | ID: covidwho-1974636

ABSTRACT

Mobile electrocardiogram (ECG) devices are valuable tools for teaching ECG interpretation. The primary purpose of this follow-up study was to determine if an ECG active learning session could be safely and effectively performed during the coronavirus disease 2019 (COVID-19) pandemic using a newly developed mobile 6-lead ECG device. Additionally, we examined the educational impact of these active learning sessions on student knowledge of cardiovascular physiology and the utility of the mobile 6-lead ECG device in a classroom setting. In this study, first-year medical students (MS1) performed four active learning activities using the new mobile 6-lead ECG device. Data were collected from 42 MS1s through a quantitative survey administered in September 2020. Overall, students felt the activity enhanced their understanding of the course material and that the activity was performed safely and in compliance with local COVID-19 guidelines. These results emphasize student preference for hands-on, small group learning activities in spite of the pandemic.


Subject(s)
COVID-19 , Education, Medical, Undergraduate , Students, Medical , Education, Medical, Undergraduate/methods , Electrocardiography , Follow-Up Studies , Humans , Pandemics , Problem-Based Learning/methods , Self Concept , United States
20.
BMJ Open ; 12(4): e057305, 2022 04 05.
Article in English | MEDLINE | ID: covidwho-1962246

ABSTRACT

OBJECTIVE: To review, inventory and compare available diagnostic tools and investigate which tool has the best performance for prehospital risk assessment in patients suspected of non-ST-segment elevation acute coronary syndrome (NSTE-ACS). METHODS: Systematic review and meta-analysis. Medline and Embase were searched up till 1 April 2021. Prospective studies with patients, suspected of NSTE-ACS, presenting in the primary care setting or by emergency medical services (EMS) were included. The most important exclusion criteria were studies including only patients with ST-elevation myocardial infarction and studies before 1995, the pretroponin era. The primary end point was the final hospital discharge diagnosis of NSTE-ACS or major adverse cardiac events (MACE) within 6 weeks. Risk of bias was evaluated by the Quality Assessment of Diagnostic Accuracy Studies Criteria. MAIN OUTCOME AND MEASURES: Sensitivity, specificity and likelihood ratio of findings for risk stratification in patients suspected of NSTE-ACS. RESULTS: In total, 15 prospective studies were included; these studies reflected in total 26 083 patients. No specific variables related to symptoms, physical examination or risk factors were useful in risk stratification for NSTE-ACS diagnosis. The most useful electrocardiographic finding was ST-segment depression (LR+3.85 (95% CI 2.58 to 5.76)). Point-of-care troponin was found to be a strong predictor for NSTE-ACS in primary care (LR+14.16 (95% CI 4.28 to 46.90) and EMS setting (LR+6.16 (95% CI 5.02 to 7.57)). Combined risk scores were the best for risk assessment in an NSTE-ACS. From the combined risk scores that can be used immediately in a prehospital setting, the PreHEART score, a validated combined risk score for prehospital use, derived from the HEART score (History, ECG, Age, Risk factors, Troponin), was most useful for risk stratification in patients with NSTE-ACS (LR+8.19 (95% CI 5.47 to 12.26)) and for identifying patients without ACS (LR-0.05 (95% CI 0.02 to 0.15)). DISCUSSION: Important study limitations were verification bias and heterogeneity between studies. In the prehospital setting, several diagnostic tools have been reported which could improve risk stratification, triage and early treatment in patients suspected for NSTE-ACS. On-site assessment of troponin and combined risk scores derived from the HEART score are strong predictors. These results support further studies to investigate the impact of these new tools on logistics and clinical outcome. FUNDING: This study is funded by ZonMw, the Dutch Organisation for Health Research and Development. TRIAL REGISTRATION NUMBER: This meta-analysis was published for registration in PROSPERO prior to starting (CRD York, CRD42021254122).


Subject(s)
Acute Coronary Syndrome , Emergency Medical Services , Acute Coronary Syndrome/diagnosis , Acute Coronary Syndrome/therapy , Electrocardiography/methods , Emergency Medical Services/methods , Humans , Prospective Studies , Risk Assessment/methods
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