Chest pain risk-stratification tools used or trialled in Ambulance Health Service settings: A Scoping Review

Introduction Patients with chest pain account for a significant proportion of ambulance attendances and Emergency Department (ED) presentations. Rapid identification of life-threatening aetiologies and differentiation from benign causes enables timely interventions and efficient utilisation of healthcare resources. Chest-pain risk-stratification tools are used throughout healthcare; their implementation into Ambulance Health Services (AHS) (i.e. Emergency Medical Services) may support ambulance clinicians with clinical decisions to safely divert patients to alternative care pathways. Objectives This scoping review maps literature describing the use and/or evaluation of chest-pain risk-stratification tools within AHS. It (1) identifies and describes tools used or trialled in adults with chest pain to stratify risk of acute coronary syndrome (ACS) or major adverse cardiac event (MACE); (2) reports key characteristics and resource requirements; and (3) describes whether tools have been validated for AHS use. Methods This scoping review was conducted following Joanna Briggs Institute (JBI) methodology and presented using PRISMA-ScR. Searches of CINAHL, MEDLINE Complete, and Scopus were performed, with grey literature searches through Google Scholar and Trove. Data was extracted using a structured data-charting approach and summarised descriptively, including frequency mapping where appropriate. Results Twenty-seven articles were identified for inclusion. Eight chest-pain risk-stratification tools were used or trialled in AHS settings, with varying degrees of validation reported. The HEART score and its derivatives were the most frequently studied, though performance varied across settings and implementation models. Tools incorporating out-of-hospital troponin testing improved risk-stratification accuracy. Conclusion Evidence describing chest-pain risk-stratification tools utilised in AHS is limited and geographically concentrated. Potential benefits include safe diversion of patients to alternative care services and reduced ED waiting times. However, broader integration is hindered by challenges associated with out-of-hospital biomarker testing. Further research is required to address barriers/enablers and to validate tools in ambulance contexts.