Rule Out of ACS in Primary Care Using a Decision Rule for Chest Pain Including Hs-troponin I POCT

NCT ID: NCT05827237

Last Updated: 2025-09-10

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

946 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-08-18

Study Completion Date

2025-04-23

Brief Summary

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The goal of this clustered, diagnostic randomized controlled trial is to study a clinical decision rule including a high-sensitive troponin I point of care test in patients with chest pain in primary care.

The main questions it aims to answer are:

1. Can unnecessary referrals to secondary care be reduced by the use of a clinical deci-sion rule in patients with new onset, non-traumatic chest pain in primary care? Compared to current daily practice.
2. What is the accuracy (sensitivity, negative prediction value) of the clinical decision rule for excluding ACS and MACE at 6 weeks and 6 months?

Detailed Description

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This clustered, diagnostic randomized controlled trial will included patients with acute chest pain consulting their general practitioner. Practices in the intervention group will use a clinical decision rule consisting of the Marburg Heart Score and a high-sensitive troponin I point of care test to exclude acute coronary syndrome (ACS) and decide upon referral. Practices in the control group will apply usual care following local guidelines.

An independent endpoint committee consisting of a cardiologist and general practitioner will adjudicate the final diagnosis. Primary endpoints are ACS and Major Adverse Cardiac Events. A delayed reference standard of 6 months will be used.

For high sensitive troponin I measurement, the Siemens Atellica VTLi immunoassay analyser is used.

Conditions

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Chest Pain Myocardial Infarction Acute Coronary Syndrome

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

A clustered randomized controlled trial in which general practices are randomized to the intervention- or control group in 2:1 ratio.
Primary Study Purpose

DIAGNOSTIC

Blinding Strategy

NONE

Study Groups

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Clinical decision rule

Patients in whom the clinical decision rule is used to exclude acute coronary syndrome

Group Type EXPERIMENTAL

Clinical decision rule

Intervention Type DIAGNOSTIC_TEST

Clinical decision rule for acute chest pain, consisting of the Marburg Heart Score (5 questions) combined with a high-sensitive troponin I point of care test

Standard care

Patients in whom the general practitioner decides upon referral following local guidelines.

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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Clinical decision rule

Clinical decision rule for acute chest pain, consisting of the Marburg Heart Score (5 questions) combined with a high-sensitive troponin I point of care test

Intervention Type DIAGNOSTIC_TEST

Eligibility Criteria

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Inclusion Criteria

* ≥18 years of age
* Acute chest pain
* Seen by general practitioner

Exclusion Criteria

* \<1 hour since onset of symptoms
* Inability to speak or understand Dutch
* Hemodynamic instability
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Maastricht Universitair Medisch Centrum

UNKNOWN

Sponsor Role collaborator

VieCuri Medical Centre

OTHER

Sponsor Role collaborator

ZonMw: The Netherlands Organisation for Health Research and Development

OTHER

Sponsor Role collaborator

Leiden University Medical Center

OTHER

Sponsor Role lead

Responsible Party

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Tobias N Bonten, MD PhD

Assistant professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Tobias Bonten, MD PhD

Role: PRINCIPAL_INVESTIGATOR

LUMC

Locations

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Leiden University Medical Center

Leiden, South Holland, Netherlands

Site Status

Countries

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Netherlands

References

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van den Bulk S, Petrus AHJ, Willemsen RTA, Boogers MJ, Meeder JG, Rahel BM, van den Akker-van Marle ME, Numans ME, Dinant GJ, Bonten TN. Ruling out acute coronary syndrome in primary care with a clinical decision rule and a capillary, high-sensitive troponin I point of care test: study protocol of a diagnostic RCT in the Netherlands (POB HELP). BMJ Open. 2023 Jun 8;13(6):e071822. doi: 10.1136/bmjopen-2023-071822.

Reference Type DERIVED
PMID: 37290947 (View on PubMed)

Related Links

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http://www.pobhelp.nl

Up to date information about the study for patients and general practitioners (Dutch)

https://trialsearch.who.int/Trial2.aspx?TrialID=NL9525

Original registration on www.NTR.nl before start of the study

Other Identifiers

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p20.013

Identifier Type: -

Identifier Source: org_study_id

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