No need to wait for chest pain diagnosis
Patients with chest pain have traditionally been required to undergo long periods of observation in emergency departments before being deemed safe for discharge. Now, South Australian researchers have found that assessment times for patients presenting with chest pains can be safely reduced, easing pressure on often overcrowded emergency departments.
Patients with suspected acute coronary syndrome (ACS) account for about 10% of the 7 million presentations at Australian EDs every year — and while it is critical that patients with chest pain and shortness of breath present at emergency departments, a large proportion of these patients are found not to be having a heart attack.
More than 3000 patients participated in the RAPID-TnT (Rapid Assessment of Possible ACS In the emergency Department with high sensitivity Troponin T) trial at four metropolitan hospitals in Adelaide between August 2015 and 2019. The trial focused on a more sensitive cardiac blood test for the protein troponin T, paired with a faster testing protocol. Elevated troponin T levels indicate damage to the heart and heart attack.
The study divided patients presenting to ED with chest pains into two groups: one which underwent RAPID-TnT testing one hour after their initial test and a second group that waited three hours between tests, in line with current protocols. The results were presented at the ESC (European Society of Cardiology) Congress 2019 and published in the journal Circulation.
The 1646 patients in the one-hour follow-up group on average spent one hour less in the emergency room and were significantly less likely to be admitted to hospital — 33.2% compared to 45.5%. The study also found that there was no difference in ongoing health issues among patients in the two groups over the following 30 days.
“We’ve shown the one-hour follow-up protocol is safe for patients,” said study leader Derek Chew, a professor at Flinders University, Network Director of Cardiology at Flinders Medical Centre and co-leader of the Lifelong Health theme at the South Australian Health and Medical Research Institute (SAHMRI).
“The benefits for the system as a whole are reducing crowding in EDs and reducing unnecessary hospital admissions.”
Prof Chew said wait times and hospital admissions could be further reduced through the development of an artificial intelligence program to support doctors’ decisions. He noted that “doctors err on the side of caution when it comes to the health of their patients”, so they would “get a great deal of confidence from an electronic system which can accurately estimate the risk of heart attack with help from a vast database of blood test results which are measured against future health outcomes”.
Prof Chew concluded, “Given the demands on our EDs, it is essential that we establish effective, evidence-based ways to quickly distinguish those who are having a heart attack from those who aren’t and who can safely go home.”
Originally published here.
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