Tonje Rambøll Johannessen

• Zangger, Martina; Jungo, Katharina Tabea; Adler, Limor; Assenova, Radost; Batic-Mujanovic, Olivera & Bracchitta, Luigi [Show all 27 contributors for this article] (2026). Long-term beta blocker prescribing after myocardial infarction in European primary care (PRACTITIONER). BMC Primary Care. 27(1). doi: 10.1186/s12875-026-03208-6. Full text in Research Archive Show summary

  Background The long-term use of beta blockers after myocardial infarction in patients with preserved ventricular function is debated. General practitioners (GPs) often decide whether to continue or discontinue long-term medications, yet little is known about how they apply evolving evidence to clinical prescribing decisions. Objective To assess whether GPs are willing to deprescribe beta blockers post myocardial infarction with preserved left ventricular function and to identify factors associated with deprescribing decisions. Design Cross-sectional online survey using case vignettes, conducted between July 2023 and October 2024 in primary care settings in 24 sites across 20 European countries. Participants Practicing GPs recruited through convenience sampling at each site. Main measures The primary outcome was whether the GP chose to deprescribe beta blockers in the vignettes. Adjusted risk ratios for the association between GP characteristics and the decision to deprescribe were estimated using Poisson regression with generalized estimating equations and robust standard errors, accounting for clustering at the GP and country level. Key results 604 GPs participated in the survey (median [IQR] age, 44.0 [35.0-54.8] years; 364 [60.3%] female), 89.2% deprescribed beta blockers in at least one vignette. The likelihood of deprescribing increased with time since myocardial infarction (adjusted risk ratio [RR] = 1.28; 95% CI 1.21–1.36 after 5 years; RR = 1.78; 95% CI 1.66–1.90 after 10 years vs. 3 months) and with side effects (RR = 1.76; 95% CI 1.66–1.88). More years of clinical experience were associated with a lower likelihood of deprescribing (RR = 0.86; 95% CI 0.77–0.95 for most vs. least experienced). Conclusions In this cross-national vignette study, most GPs were willing to deprescribe beta blockers after myocardial infarction in patients with preserved left ventricular function, particularly when time had passed and side effects were present. These findings suggest that GPs are open to applying evolving evidence on beta blocker discontinuation in clinical care.

• Johannessen, Tonje R.; Vallersnes, Odd Martin; Larstorp, Anne Cecilie Kjeldsen; Halvorsen, Sigrun & Atar, Dan (2026). Authors’ Response Letter – 30-day Outcome Data from the OUT-POC Pilot Study. Cardiology. ISSN 0008-6312. p. 5–5. doi: 10.1159/000553527. Full text in Research Archive
• Johannessen, Tonje Rambøll; Body, Richard; Mair, Johannes; Mills, Nicholas L; Cullen, Louise & Lindahl, Bertil [Show all 21 contributors for this article] (2025). New pathways with high-sensitivity cardiac troponin testing at the point of care in the ambulance and primary care. European Heart Journal: Acute Cardiovascular Care. ISSN 2048-8726. doi: 10.1093/ehjacc/zuaf157. Full text in Research Archive Show summary

  Chest pain is one of the most common reasons for emergency ambulance response. If myocardial infarction (MI) is suspected, patients are routinely conveyed to hospital for further investigations, which include one or more high-sensitivity cardiac troponin (hs-cTn) tests to confirm or exclude the diagnosis. In countries with a well-developed primary care network, chest pain is often initially assessed in a community setting. However, as no clinical decision tools can exclude MI without cardiac troponin testing, many patients are transferred to the hospital for further evaluation. With only 1 in 10 patients ultimately diagnosed with MI or an alternative serious condition requiring urgent treatment, the development of hs-cTn testing at the point of care (POC) has major potential to guide clinical decisions in a primary care and pre-hospital setting (Graphical Abstract)..

• Johannessen, Tonje Rambøll; Melessen, Indra M B; Vallersnes, Odd Martin; Manten, Amy; Halvorsen, Sigrun & Atar, Dan [Show all 7 contributors for this article] (2025). Adequately identifying low-risk chest pain in emergency primary care: evaluating the performance of preHEAR(T) based on two European cohorts. Open heart. 12(2). doi: 10.1136/openhrt-2025-003362. Full text in Research Archive Show summary

  Background Differentiating cardiac from non-cardiac acute chest pain poses a diagnostic challenge, especially in primary care. The History, ECG, Age, Risk factors and Troponin level (HEART) score aid in risk stratification in hospitals, while the prehospital HEART (preHEART) score was refined for paramedics’ use. However, its accuracy in emergency primary care has not been studied. This study evaluates the preHEAR(T) score, with and without high-sensitivity cardiac troponin (hs-cTn), as a tool to rule out acute myocardial infarction (MI) in emergency primary care. Methods Retrospective data from two European cohorts were analysed, namely the One-hoUr Troponin in a low-prevalence population of Acute Coronary Syndrome (OUT-ACS) study (1711 patients) at a Norwegian emergency primary care centre (2016–2018) and the TRiage of Acute Chest pain Evaluated in urgent primary care (TRACE) study (664 patients) at a Dutch emergency primary care centre (2017). The preHEAR (without hs-cTn) score was evaluated in both cohorts. The preHEART score was assessed in OUT-ACS only, as the TRACE study did not measure troponins. The threshold of ≤3 points has previously been determined as low risk for acute MI (AMI) and optimal for rule-out purposes. The primary outcome was diagnostic performance for ruling out MI, and the secondary outcome was the composite of 90-day AMI or all-cause death. Results In OUT-ACS, 3.6% of patients had an AMI (median age 56 years (45–68); 47.7% female), and 3% in TRACE (median age 48 years (32–67); 56.9% female). PreHEAR identified 49.3% (OUT-ACS) and 82.7% (TRACE) as low risk, while preHEART identified 33.6% (OUT-ACS) as low risk. Sensitivity/specificity for AMI were 63.9% (95% CI 50.6 to 75.8)/49.8% (95% CI 47.3 to 52.7) (OUT-ACS) and 65% (95% CI 40.8 to 84.6)/84.2% (95% CI 81.1 to 86.9) (TRACE) for preHEAR and 93.4% (95% CI 84.1 to 98.2)/34.6% (95% CI 32.2 to 37) for preHEART. For the secondary outcome, similar diagnostic performance metrics were found. There were four missed AMI cases in the low-risk preHEART group, who were all female. Conclusion Neither the preHEAR nor preHEART scores provide sufficient rule out safety in emergency primary care and may particularly underestimate AMI risk in females. Trial registration number OUT-ACS: clinicaltrials.gov NCT02983123 . TRACE: Netherlands Trial Registry (NL-OMON20102); https://onderzoekmetmensen.nl/nl/trial/20102 .

• Johannessen, Tonje Rambøll; Vallersnes, Odd Martin; Larstorp, Anne Cecilie Kjeldsen; Halvorsen, Sigrun & Atar, Dan (2025). One-Hour Troponin Using a High-Sensitivity Point-of-Care Assay in Emergency Primary Care: The OUT-POC Pilot Study. Cardiology. ISSN 0008-6312. doi: 10.1159/000545127. Full text in Research Archive Show summary

  Introduction: Novel point-of-care (POC) high-sensitivity cardiac troponin (hs-cTn) tests could enhance acute myocardial infarction (MI) assessment outside hospital. This pilot study evaluates the efficacy, feasibility, and precision of the QuidelOrtho TriageTrue hs-cTnI POC assay when used by non-laboratory personnel in emergency primary care. Methods: A prospective pilot study was conducted from April to June 2024 at the main emergency primary care clinic in Oslo, Norway. Patients ≥18 years with acute nontraumatic chest pain were eligible. The 0/1-h diagnostic algorithms for the POC TriageTrue hs-cTnI and the Roche Elecsys hs-cTnT central laboratory assay (routine protocol) were compared to assess the efficacy and potential safety issues for patients triaged to MI rule-out. Results: Over 2 months, 199 patients (median age 54 years [interquartile range 45–70]; 52.8% female) were included. Five (2.5%) patients were hospitalised with acute MI. After a single hs-cTnI measurement, the POC algorithm categorised more patients to direct rule-out than the hs-cTnT assay (65% vs. 32%). The rule-out efficacy was similar for both assays after adding the 1-hour measurement (hs-cTnT 74%; POC hs-cTnI 73%). Device-related error rates were low (0.5%), with high reproducibility and repeatability (coefficients of variation < 10%) when performed by non-laboratory personnel. Conclusion: The 0/1-h algorithm for the TriageTrue hs-cTnI POC assay appears efficient, feasible, and robust when applied by personnel without laboratory expertise in an emergency primary care setting. Further research is warranted, but given the high proportion of single-sample rule-out cases, 1-h measurements could likely be avoided, improving patient management.

• Johannessen, Tonje Rambøll; Ruud, Sven Eirik; Larstorp, Anne Cecilie Kjeldsen; Atar, Dan; Halvorsen, Sigrun & Nilsen, Beate [Show all 7 contributors for this article] (2025). Rapid rule-out of acute myocardial infarction using the 0/1-hour algorithm for cardiac troponins in emergency primary care: the OUT-ACS implementation study. BMC Primary Care. 26(1). doi: 10.1186/s12875-025-02723-2. Full text in Research Archive Show summary

  Background Acute chest pain has a high hospital referral rate due to the limited ability to exclude acute myocardial infarction (MI) in primary care. We aimed to evaluate the effectiveness of implementing the European Society of Cardiology (ESC) 0/1-hour algorithm for high-sensitivity cardiac troponin T (hs-cTnT) testing in emergency primary care. Methods In a prospective study (April-October 2023), the ESC 0/1-hour algorithm for hs-cTnT was implemented at the main emergency primary care clinic in Oslo, Norway. All consecutive patients ≥ 18 years with acute non-traumatic chest pain having hs-cTnT measurements done were registered. The patients were assigned to MI rule-out, rule-in, or further observation using the algorithm. Patients in the observation group had a 4-hour hs-cTnT measurement done. The outcome measures were the proportion of patients conclusively assessed by the protocol, personnel adherence, reduction in length of stay (LOS) compared to the previous 0/4-hour protocol (historical cohort), and disposition. Results During six months, hs-cTnT measurements were conducted in 32.6% (995/3053) of chest pain patients (median age 58 years (IQR 45–68); 50.6% female). A single hs-cTnT measurement assigned 24.1% (n = 240/995) towards MI rule-out, suitable for early discharge, increasing to 63.8% after adding a 1-hour measurement. The observation group (319/995, 32.1%) was reduced to 23.0% (229/995) after a 4-hour measurement. A total of 77.0% of the patients were conclusively assigned to either rule-out or rule-in group. The personnel adhered well to the new protocol, with a median 1-hour sampling interval of 63 min (IQR 60–66) and 4.6 h (IQR 4.1–5.5) for the 4-hour sample. The protocol was misinterpreted or overruled in 8.6% of the cases. Compared to the previous 0/4-hour protocol, LOS was reduced by -2.2 h (95% confidence intervals − 2.6 to -1.7). After completed assessment at the clinic, 14.8% were transferred to hospital, where 20 patients were diagnosed with an MI. The remaining patients were sent home or managed in the outpatient setting; any occurrence of MIs in this group is unknown. Conclusions The ESC 0/1-hour algorithm effectively assesses low-risk acute chest pain in emergency primary care, reinforcing its gatekeeper role by managing these patients at a lower level of care.

• Johannessen, Tonje Rambøll; Halvorsen, Sigrun; Atar, Dan; Munkhaugen, John; Nore, Anne Kathrine & Wisløff, Torbjørn [Show all 7 contributors for this article] (2022). Cost-effectiveness of a rule-out algorithm of acute myocardial infarction in low-risk patients: emergency primary care versus hospital setting. BMC Health Services Research. 22(1). doi: 10.1186/s12913-022-08697-6. Full text in Research Archive Show summary

  Aims: Hospital admissions of patients with chest pain considered as low risk for acute coronary syndrome contribute to increased costs and crowding in the emergency departments. This study aims to estimate the cost-effectiveness of assessing these patients in a primary care emergency setting, using the European Society of Cardiology (ESC) 0/1-h algorithm for high-sensitivity cardiac troponin T, compared to routine hospital management. Methods: A cost-effectiveness analysis was conducted. For the primary care estimates, costs and health care expenditure from the observational OUT-ACS (One-hoUr Troponin in a low-prevalence population of Acute Coronary Syndrome) study were compared with anonymous extracted administrative data on low-risk patients at a large general hospital in Norway. Patients discharged home after the hs-cTnT assessment were defined as low risk in the primary care cohort. In the hospital setting, the low-risk group comprised patients discharged with a non-specific chest pain diagnosis (ICD-10 codes R07.4 and Z03.5). Loss of health related to a potential increase in acute myocardial infarctions the following 30-days was estimated. The primary outcome measure was the costs per quality-adjusted life year (QALY) of applying the ESC 0/1-h algorithm in primary care. The secondary outcomes were health care costs and length of stay in the two settings. Results: Differences in costs comprise personnel and laboratory costs of applying the algorithm at primary care level (€192) and expenses related to ambulance transports and complete hospital costs for low-risk patients admitted to hospital (€1986). Additional diagnostic procedures were performed in 31.9% (181/567) of the low-risk hospital cohort. The estimated reduction in health care cost when using the 0/1-h algorithm outside of hospital was €1794 per low-risk patient, with a mean decrease in length of stay of 18.9 h. These numbers result in an average per-person QALY gain of 0.0005. Increased QALY and decreased costs indicate that the primary care approach is clearly cost-effective. Conclusion: Using the ESC 0/1-h algorithm in low-risk patients in emergency primary care appears to be cost-effective compared to standard hospital management, with an extensive reduction in costs and length of stay per patient.

• Johannessen, Tonje Rambøll; Halvorsen, Sigrun; Atar, Dan & Vallersnes, Odd Martin (2022). Performance of the Novel Observation Group Criteria of the European Society of Cardiology (ESC) 0/1-Hour Algorithm in a Low-Risk Population. Journal of the American Heart Association (JAHA). 11(7). doi: 10.1161/JAHA.121.024927. Full text in Research Archive
• Chiang, Cho-Han; Chiang, Cho-Hung; Pickering, John W; Stoyanov, Kiril M.; Chew,, Derek P. & Neumann, Johannes T. [Show all 38 contributors for this article] (2021). Performance of the European Society of Cardiology 0/1-Hour, 0/2-Hour, and 0/3-Hour Algorithms for Rapid Triage of Acute Myocardial Infarction. An International Collaborative Meta-analysis. Annals of Internal Medicine. ISSN 0003-4819. doi: 10.7326/M21-1499. Full text in Research Archive
• Johannessen, Tonje R.; Atar, Dan; Vallersnes, Odd Martin; Larstorp, Anne Cecilie Kjeldsen; Mdala, Ibrahimu & Halvorsen, Sigrun (2021). Comparison of a single high-sensitivity cardiac troponin T measurement with the HEART score for rapid rule-out of acute myocardial infarction in a primary care emergency setting: a cohort study. BMJ Open. 11(2), p. e046024–e046024. doi: 10.1136/bmjopen-2020-046024. Full text in Research Archive Show summary

  Objective This study aims to compare the rule-out safety of a single high-sensitivity cardiac troponin T (hs-cTnT) with the History, ECG, Age, Risk factors and Troponin (HEART) score in a low-prevalence primary care setting of acute myocardial infarction (AMI). Participants Patients with non-specific symptoms suggestive of AMI were consecutively enroled at a primary care emergency clinic in Oslo, Norway from November 2016 to October 2018. Methods After initial assessment by a general practitioner, hs-cTnT samples were drawn. AMI was ruled-out by a single hs-cTnT <5 ng/L measured ≥3 hours after symptom onset. The HEART score was calculated retrospectively; a score ≤3 of 10 points was considered low risk. We also calculated a modified HEART score using more sensitive hs-cTnT thresholds. The primary outcome was the diagnostic performance for the rule-out of AMI at the index event; the secondary the composite of AMI or all-cause death at 90 days. Results Among 1711 patients, 61 (3.6%) were diagnosed with AMI, and 569 (33.3%) patients were assigned to single rule-out (<5 ng/L). With no AMIs in this group, the negative predictive value (NPV) and sensitivity were both 100.0% (95% CI 99.4% to 100.0% and 94.1% to 100.0%, respectively), and the specificity 34.5% (32.2% to 36.8%). The original HEART score triaged more patients as low risk (n=871), but missed five AMIs (NPV 99.4% (98.7% to 99.8%); sensitivity 91.8% (81.9% to 97.3%) and specificity 52.5% (50.0% to 54.9%)). The modified HEART score increased the low-risk sensitivity to 98.4% (91.2% to 100.0%), with specificity 38.7% (36.3% to 41.1%). The 90-day incidence of AMI or death in the single rule-out and the original and modified low-risk HEART groups were 0.0%, 0.7%, and 0.2%, respectively. Conclusion In a primary care emergency setting, a single hs-cTnT strategy was superior to the HEART score in ruling out AMI. This rapid and safe approach may enhance the assessment of patients with chest pain outside of hospitals.

• Johannessen, Tonje R.; Vallersnes, Odd Martin; Halvorsen, Sigrun; Larstorp, Anne Cecilie Kjeldsen; Mdala, Ibrahimu & Atar, Dan (2020). Pre-hospital One-Hour Troponin in a Low-Prevalence Population of Acute Coronary Syndrome: OUT-ACS study. Open heart. 7:e001296, p. 1–9. doi: 10.1136/openhrt-2020-001296. Full text in Research Archive Show summary

  Objective The European Society of Cardiology 0/1-hour algorithm for high-sensitivity cardiac troponin T (hs-cTnT) has demonstrated high rule-out safety in large hospital validation cohorts. We aimed to validate the algorithm in a primary care setting, where patients have a lower pretest probability for acute coronary syndrome. Methods This prospective, observational, diagnostic study included patients with acute non-specific chest pain admitted to a primary care emergency clinic in Oslo, Norway, from November 2016 to October 2018. hs-cTnT was measured after 0, 1 and 4 hours. The primary outcome measure was the diagnostic performance of the 0/1-hour algorithm, the 90-day incidence of AMI or all-cause death the secondary. Results Among 1711 included patients, 61 (3.6%) were diagnosed with AMI. By applying the algorithm, 1311 (76.6%) patients were assigned to the rule-out group. The negative predictive value was 99.9% (95% CI 99.5% to 100.0%), the sensitivity and specificity 98.4% (91.2–100.0) and 79.4% (77.4–81.3), respectively. Sixty-six (3.9%) patients were triaged towards rule-in, where 45 were diagnosed with AMI. The corresponding positive predictive value was 68.2% (58.3–76.7), sensitivity 73.8% (60.9–84.2), and specificity 98.7% (98.1–99.2). Among 334 (19.5%) patients assigned to the observation group in need of further tests, 15 patients had an AMI. The following 90 days, five new patients experienced an AMI and nine patients died, with a low incidence in the rule-out group (0.3%). Conclusion The 0/1-hour algorithm for hs-cTnT seems safe, efficient and applicable for an accelerated assessment of patients with non-specific chest pain in a primary care emergency setting.

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• Johannessen, Tonje Rambøll (2026). Høysensitiv troponinmåling på legevakt. Full text in Research Archive
• Johannessen, Tonje Rambøll (2026). Point-of-Care High-Sensitivity Troponin Testing for Rapid Chest Pain Triage in Emergency Primary Care: Preliminary Single-Sample Efficacy Findings from the OUT-POC Study. Full text in Research Archive
• Johannessen, Tonje Rambøll; Atar, Dan; Halvorsen, Sigrun; Munkhaugen, John; Vallersnes, Odd Martin & Bakken, Arnhild [Show all 7 contributors for this article] (2026). Point-of-Care High-Sensitivity Troponin Testing for Rapid Chest Pain Triage in Emergency Primary Care: Preliminary Single-Sample Efficacy Findings from the OUT-POC Study. Full text in Research Archive
• Johannessen, Tonje Rambøll (2026). High-sensitivity cardiac troponin testing in emergency primary care, ICEM. Full text in Research Archive Show summary

  Symposium: “Beyond the emergency department: opportunities and operational realities of POC testing in ambulances and emergency primary care”, with Prof Cullen and Prof Backus.

• Johannessen, Tonje Rambøll; Davidsen, Anne Herefoss; Halvorsen, Peder Andreas & Brodersen, John (2026). Symposium - Stethoscopes, troponins and smartwatches: Tools in the right hands? Full text in Research Archive
• Johannessen, Tonje Rambøll (2026). High-sensitivity cardiac troponin testing at the point of care in emergency primary care. Full text in Research Archive
• Johannessen, Tonje Rambøll (2026). Håndtering av akutte brystsmerter på legevakt, NMTG-samling. Full text in Research Archive
• Johannessen, Tonje Rambøll (2025). OUT-POC-studien (One-hoUr Troponin using a high-sensitivity Point-Of-Care assay in emergency primary care). Full text in Research Archive
• Johannessen, Tonje Rambøll (2025). Håndtering av akutte brystsmerter på legevakt, Legevaktskonferansen. Full text in Research Archive
• Johannessen, Tonje Rambøll; Atar, Dan; Larstorp, Anne Cecilie Kjeldsen; Halvorsen, Sigrun & Vallersnes, Odd Martin (2025). One-hoUr Troponin using a high-sensitivity Point-Of-Care assay in emergency primary care: OUT-POC-pilotstudien. Full text in Research Archive
• Johannessen, Tonje Rambøll; Vallersnes, Odd Martin; Larstorp, Anne Cecilie Kjeldsen; Halvorsen, Sigrun & Atar, Dan (2025). Authors' Response Letter - Expanding the Use of Point-of-Care hs-cTnI in Emergency Primary Care: Insights from the OUT-POC Pilot Study. Cardiology. ISSN 0008-6312. p. 3–3. doi: 10.1159/000546344. Full text in Research Archive
• Johannessen, Tonje Rambøll; Vallersnes, Odd Martin; Austad, Bjarne; Andrup, Simon Johan Mattias; Davidsen, Anne Herefoss & PRYTZ, MARTHE H. [Show all 8 contributors for this article] (2025). Brystsmerter på legevakt: Bruk av høysensitiv troponin. Utposten. ISSN 0800-5680. 7/2025, p. 18–21. doi: https:/www.utposten.no/journal/2025/7. Full text in Research Archive Show summary

  Brystsmerter er en vanlig problemstilling på legevakt, og årsaken kan være alt fra panikkangst og interkostale myalgier til livstruende tilstander som akutt hjerteinfarkt. Det kan være krevende å være legevaktslege i denne diagnostiske spagaten, særlig hvis pasienten egentlig ikke er så klinisk dårlig og det ikke er EKG-forandringer. Mange velger å legge inn pasienten for sikkerhets skyld. Høysensitiv troponinmåling på legevakt kan bidra til at flere pasienter avklares med høy grad av sikkerhet i primærhelsetjenesten. Det vil bidra til sikrere diagnostikk og trygghet for legevaktslegen, bedre forløp for pasientene og mer tid til de alvorlig syke pasientene i akuttmottakene.

• Johannessen, Tonje Rambøll; Vallersnes, Odd Martin; Larstorp, Anne Cecilie Kjeldsen; Halvorsen, Sigrun & Atar, Dan (2025). One-Hour Troponin Using a High-Sensitivity Point-of-Care Assay in Emergency Primary Care: The OUT-POC Pilot Study. Full text in Research Archive
• Johannessen, Tonje Rambøll (2024). Rapid rule-out of acute myocardial infarction using the 0/1-hour algorithm for cardiac troponins in emergency primary care: the OUT-ACS implementation study. Full text in Research Archive
• Johannessen, Tonje Rambøll (2024). Rapid rule-out of acute myocardial infarction using the 0/1-hour algorithm for cardiac troponins in emergency primary care: the OUT-ACS implementation study. Full text in Research Archive
• Johannessen, Tonje Rambøll; Vallersnes, Odd Martin; Atar, Dan; Halvorsen, Sigrun; Larstorp, Anne Cecilie Kjeldsen & Nilsen, Beate [Show all 7 contributors for this article] (2024). Rapid rule-out of acute myocardial infarction using troponins in emergency primary care: the OUT-ACS implementation study. Full text in Research Archive
• Johannessen, Tonje Rambøll; Vallersnes, Odd Martin; Atar, Dan; Halvorsen, Sigrun; Larstorp, Anne Cecilie Kjeldsen & Ruud, Sven Eirik [Show all 7 contributors for this article] (2024). Rapid rule-out of acute myocardial infarction using the 0/1-hour algorithm for cardiac troponins in emergency primary care. The OUT-ACS implementation study. Full text in Research Archive
• Johannessen, Tonje Rambøll; Vallersnes, Odd Martin; Atar, Dan; Halvorsen, Sigrun; Melessen, Indra & Manten, Amy [Show all 7 contributors for this article] (2024). Identifying low-risk chest pain in out-of-hours primary care: the diagnostic performance of preHEAR and preHEART scores based on two European cohorts. Full text in Research Archive
• Melessen, Indra; Vallersnes, Odd Martin; Harskamp, Ralf E.; Atar, Dan; Halvorsen, Sigrun & Manten, Amy [Show all 7 contributors for this article] (2024). Safety and efficiency of modified HEART scores without troponin or electrocardiography: an analysis based on two European out-of-hours primary care cohorts. Full text in Research Archive
• Johannessen, Tonje Rambøll (2023). Anvendelse av troponin på legevakt for å utelukke akutt hjerteinfakt: OUT-ACS-studien (One-hoUr Troponin in a low-prevalence population of Acute Coronary Syndrome). Full text in Research Archive
• Emilsson, Louise; Brænd, Anja Maria Lyche; Dahli, Mina; Johannessen, Tonje Rambøll & Skonnord, Trygve (2023). Designing a new elective subject for third-year medical students on navigating medical guidelines. Full text in Research Archive Show summary

  Background: Understanding how to navigate medical guidelines is an essential skill for future doctors. Recent emphasis has been placed on the importance of prioritization and time management when implementing guidelines into clinical practice. However, traditional medical education is offered topic by topic, with less emphasis given to patient-centred care, grading of recommendations and sometimes conflicting guidelines. Methods: Our objective was to develop a two-week elective subject titled "The Medical Profession: Navigating Medical Guidelines" for third-year medical students in Oslo. Through an intensive application of the nominal group technique (NGT), a group of five experienced primary care physicians and teachers collaborated during a two-day session to design the subject and its curriculum. Initially, we had concerns about the complexity of this topic for students at the third-year level due to their limited clinical experience. To assess the subject, the examination was designed to include an individual reflection note and a group presentation. Out of 16 students, 14 consented to having their reflection notes used for educational research purposes. Results: The NGT process led to development of a subject with interactive lectures, group and plenary discussions, as well as a clinical rotation day. Key topics included research guidelines, sensible choices and sustainability, patient-centered care, medical uncertainty, multi-morbidity, and navigating conflicting guidelines. A longitudinal patient-case video presentation accompanied the teaching with increasing complexity each day. Students were divided into two groups for the clinical rotation day at out-of-hour emergency care and nursing home facilities. Two teachers were present each day of the course to facilitate skill development and discussions. Students provided positive feedback, appreciating the reflection on their future professional roles. Conclusion(s): The NGT process proved effective in creating an elective subject well-received by both teachers and students. We encourage others to consider using similar models when designing new curricula.

• Emilsson, Louise; Brænd, Anja Maria Lyche; Johannessen, Tonje Rambøll; Dahli, Mina & Skonnord, Trygve (2023). Development of a new elective subject for third-year students on navigating medical guidelines. Full text in Research Archive
• Johannessen, Tonje Rambøll; Halvorsen, Sigrun; Atar, Dan; Munkhaugen, John; Nore, Anne Kathrine & Wisløff, Torbjørn [Show all 7 contributors for this article] (2021). Cost-minimization analysis of acute myocardial infarction rule-out in low-risk patients: emergency primary care versus hospital. Full text in Research Archive
• Johannessen, Tonje Rambøll; Halvorsen, Sigrun; Atar, Dan; Munkhaugen, John; Nore, Anne Kathrine & Wisløff, Torbjørn [Show all 7 contributors for this article] (2021). Cost-minimisation analysis of acute myocardial infarction rule-out in low-risk patients: primary care emergency setting versus hospital setting. Full text in Research Archive
• Johannessen, Tonje R.; Vallersnes, Odd Martin; Larstorp, Anne Cecilie Kjeldsen; Mdala, Ibrahimu; Atar, Dan & Halvorsen, Sigrun (2020). Fast prehospital rule-out using a high-sensitivity cardiac Troponin T assay in a low-prevalence population for Acute Coronary Syndrome (The OUT-ACS study). Full text in Research Archive
• Johannessen, Tonje R.; Atar, Dan; Vallersnes, Odd Martin; Larstorp, Anne Cecilie Kjeldsen; Mdala, Ibrahimu & Halvorsen, Sigrun (2020). A single high-sensitivity cardiac troponin T compared to the HEART score for a rapid rule-out of acute myocardial infarction at a prehospital emergency clinic. Full text in Research Archive
• Johannessen, Tonje R.; Atar, Dan; Vallersnes, Odd Martin; Larstorp, Anne Cecilie Kjeldsen; Mdala, Ibrahimu & Halvorsen, Sigrun (2020). A single high-sensitivity cardiac troponin T compared to the HEART score for a rapid rule-out of acute myocardial infarction at a prehospital emergency clinic. European Heart Journal. ISSN 0195-668X. 41. doi: 10.1093/ehjci/ehaa946.1680. Full text in Research Archive
• Johannessen, Tonje R.; Vallersnes, Odd Martin; Halvorsen, Sigrun; Larstorp, Anne Cecilie Kjeldsen; Mdala, Ibrahimu & Atar, Dan (2019). Prehospital assessment of the One-hoUr rule-in/rule-out algorithm using a high-sensitivity cardiac Troponin T assay in a low-prevalence population for Acute Coronary Syndrome (OUT-ACS) (Abstract presentation). Full text in Research Archive
• Johannessen, Tonje R.; Vallersnes, Odd Martin; Halvorsen, Sigrun; Larstorp, Anne Cecilie Kjeldsen; Mdala, Ibrahimu & Atar, Dan (2019). Prehospital assessment of the One-hoUr rule-in/rule-out algorithm using a high-sensitivity cardiac Troponin T assay in a low-prevalence population for Acute Coronary Syndrome (OUT-ACS) (Poster og vitenskaplig foredrag). Full text in Research Archive
• Johannessen, Tonje R.; Vallersnes, Odd Martin; Halvorsen, Sigrun; Larstorp, Anne Cecilie Kjeldsen; Mdala, Ibrahimu & Atar, Dan (2019). Prehospital assessment of the One-hoUr rule-in/rule-out algorithm using a high-sensitivity cardiac Troponin T assay in a low-prevalence population for Acute Coronary Syndrome (OUT-ACS) (Abstract presentation). European Heart Journal. ISSN 0195-668X. 40. doi: 10.1093/eurheartj/ehz745.0062. Full text in Research Archive
• Johannessen, Tonje R.; Vallersnes, Odd Martin; Mdala, Ibrahimu; Larstorp, Anne Cecilie Kjeldsen; Atar, Dan & Halvorsen, Sigrun (2019). Prehospital assessment of the One-hoUr rule-in/rule-out algorithm using a high-sensitivity cardiac Troponin T assay in a low-prevalence population for Acute Coronary Syndrome (OUT-ACS study). Full text in Research Archive
• Johannessen, Tonje R.; Vallersnes, Odd Martin; Halvorsen, Sigrun; Larstorp, Anne Cecilie Kjeldsen; Mdala, Ibrahimu & Atar, Dan (2019). OUT-ACS studien: Anvendelse av 0/1-times algoritme for høysensitiv hjertespesifikk Troponin-T for avklaring av NSTEMI på Observasjonsposten ved Legevakten i Oslo. Full text in Research Archive
• Johannessen, Tonje R. (2018). OUT-ACS-studien: One-hoUr Troponin in a low-prevalence population for Acute Coronary Syndrome. Full text in Research Archive
• Johannessen, Tonje Rambøll (2022). Ruling out acute myocardial infarction in emergency primary care: The OUT-ACS study (One-hoUr Troponin in a low-prevalence population of Acute Coronary Syndrome). Universitetet i Oslo. Full text in Research Archive Show summary

  Chest pain is a frequent presenting symptom in emergency primary care, challenging due to the lack of sensitive diagnostic tools to exclude an acute myocardial infarction (AMI). The consequent clinical uncertainty contributes to high hospital referral rates of low-risk patients, congested emergency departments, and extensive use of healthcare resources and procedures of limited added value. The observational OUT-ACS (One-hoUr Troponin in a low-prevalence population of Acute Coronary Syndrome) study was conducted from 2016 to 2018 at a large emergency primary care clinic in Oslo, Norway. The aim was to investigate whether AMI could be excluded in low-risk patients using a 0/1-hour algorithm for high-sensitivity cardiac troponin T (hs-cTnT). AMI was adjudicated in 61 (3.6%) of 1711 patients. The patients were categorised as rule-out, rule-in or further observation by the algorithm, following the European Society of Cardiology guidelines. For patients assigned to the large AMI rule-out group (76.6 %), the algorithm achieved high safety at the index episode and had few events in the following 90 days. A total of 4% was assigned towards rule-in with a moderate AMI accuracy. The overall efficacy and safety of the algorithm were further improved by applying novel criteria for patients in the observation group. We also found that the rule-out performance of a single troponin measurement was superior to the HEART (History, ECG, Age, Risk factors and Troponin) score in our low-risk cohort. Finally, assessing low-risk patients with chest pain in emergency primary care was shown to be cost-effective, with €1794 saved per low-risk patient and a mean decrease in length of stay of 18.9 hours compared to routine hospital management. Based on our findings, the 0/1-hour algorithm appears safe, efficient, and cost-effective for assessing low-risk patients with chest pain in emergency primary care.

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