Ruling out ACS in the pre-hospital setting could have major medical and economic value. Schols et al. conducted a nationwide flash-mob study in the Netherlands to evaluate the safety of the Marburg Heart Score (MHS) to rule out ACS [
20]. The MHS is a clinical decision rule based on five signs and symptoms, which was designed to identify patients with a low probability of ACS as the underlying cause of chest pain in the primary care population [
21,
22]. Although ruling out ACS in the primary care setting without additional tests, such as the ECG and cardiac troponin measurements, sounds attractive, Schols et al. showed that ACS could not be safely ruled out using the MHS. The FamouS Triage study group has shown that it is possible to identify low-risk patients in the pre-hospital setting by assessing the modified History, Electrocardiogram, Age, Risk factors and Troponin (HEART) score [
23,
24]. Moreover, they have shown that incorporating a point-of-care (POC) troponin T test into the HEART score enables ambulance paramedics to assess the complete HEART score and rule out ACS in low-risk patients at home [
25]. In order to further evaluate the possibilities of ruling out ACS at home, the ARTICA (
Acute
Rule out of non‑S
T elevation acute coronary syndrome in the pre-hospital setting by HEART score assessment and a single po
Int-of-
CAre troponin) trial is currently being conducted [
26]. The ARTICA trial is a randomised trial with a primary objective to evaluate the cost-effectiveness of ruling out ACS at home. Low-risk patients are identified by assessment of the H, E, A and R components of the HEART score and then randomised to either transfer to the ED (standard care) versus POC troponin T measurement at home. If the POC troponin T value is below the limit of detection (40 ng/l), an ACS is considered ruled out and the care of the patient is transferred to the general practitioner.