Australian researchers investigated how a new system of rapid blood tests for heart attack could help doctors to make earlier decisions about patient care.
In Australia, around 30,000 patients a year visit the emergency department complaining of chest pain, a symptom associated with a heart attack. Deciding which patients have had a heart attack and need further hospital treatment and who can be safely discharged home is an important issue for healthcare staff. A highly sensitive blood test that measures levels of Troponin T, a cardiac muscle protein, can help doctors to diagnose a heart attack. Troponin T is released into the bloodstream after cardiac muscle injury. So, observing a rise in Troponin T blood levels, combined with results of other clinical tests, can help to confirm heart attack diagnosis. Researchers in Adelaide, Australia, carried out a large study to investigate the best way to use high sensitivity Troponin T blood tests, in order to safely distinguish between heart attack patients and those who can be discharged home. They presented their findings at the European Society of Cardiology World Conference in Paris, 4 Sept 2019.
High sensitivity Troponin T blood tests help to diagnose heart attack
Between August 2015 and April 2019, over 3,300 patients with suspected heart attack attending four emergency departments in Adelaide, were randomly assigned either to have Troponin T blood tests on admission and retested one hour later, or on admission and retested three hours later. All patients also had other tests that are routinely used in the emergency department to assess suspected heart attack, including clinical examination and ECG. Both groups were carefully monitored during their hospital attendance and for the following 30 days to check their healthcare outcomes.
Patients in the one-hour retesting group spent on-average one hour less in the emergency department and were significantly less likely to be admitted to hospital (33.2% in the one-hour group compared to 45.5% in the three-hour group). There was no difference in healthcare outcomes between the two groups.
Rapid high sensitivity Troponin T blood tests reduce wait times and admissions
The researchers concluded that the one-hour testing method with high sensitivity Troponin T blood tests is a safe way to help identify heart attack patients. It allows more rapid decision-making, reduced time in the emergency department and fewer hospital admissions.
“The benefits for the system as a whole are reducing crowding in emergency departments and reducing unnecessary hospital admissions,” said Professor Derek Chew, the lead author of the study. He hopes that waiting times could be reduced further by developing an artificial intelligence program to support doctors’ treatment decisions. “[Doctors] 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,” said Professor Chew.
Written by Julie McShane, MA MB BS
1. Chew DP, Lambrakis K, Blyth A, et al. A randomized trial of a 1-hour troponin T protocol in suspected acute coronary syndromes: the rapid assessment of possible ACS in the emergency department with high sensitivity troponin T (RAPID-TnT) study. Circulation Doi:10.1161/CirculationJA.119.042891.
2. Flinders University, Press release 3 September 2019. “World-first cardio trial shows shorter wait times and admissions” https://www.eurekalert.org/pub_releases/2019-09/fu-wct090119.php
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