September 3, 2019 — Assessment times for patients presenting with chest pain can be safely reduced, easing pressure on often over-crowded emergency departments, according to a major study. The South Australian study also found that shorter time gaps between assessments led to a reduced likelihood of hospital admission.
More than 3000 patients participated in the study at four metropolitan hospitals in Adelaide, South Australia between August 2015 and 2019. The RAPID-TnT trial focused on a more sensitive cardiac blood test for the protein called Troponin T, paired with a faster testing protocol.
Elevated Troponin T levels indicate damage to the heart and heart attack.
Patients with chest pain have traditionally been required to undergo long periods of observation in emergency departments before being deemed safe for discharge.
The new study divided patients presenting to ED with chest pain into two groups: one which underwent RAPID-TnT (Rapid Assessment of Possible ACS In the emergency Department with high sensitivity Troponin T) testing one hour after their initial test and a second group that waited three hours between tests, in line with current protocols.
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 per cent compared to 45.5 per cent.
Led by Flinders University Professor Derek Chew 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,” Professor Chew said.
“The benefits for the system as a whole are reducing crowding in EDs and reducing unnecessary hospital admissions.”
Professor Chew, who is also 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) in Adelaide, will present the findings this week at the European Society of Cardiology world conference in Paris.
“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,” he said.
“While it is critical that patients with chest pain and shortness of breath present at emergency departments, we know upon investigation that a large proportion of these patients are not having a heart attack.”
Patients with suspected acute coronary syndrome (ACS) account for about 10 per cent of the 7 million presentations at Australian EDs every year.
Professor Chew said wait times and hospital admissions could be further reduced through the development of an artificial intelligence program to support doctors’ decisions.
“Understandably, doctors err on the side of caution when it comes to the health of their patients,” he said.
“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.”
A paper reflecting the study results, ‘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’ (2019), by DP Chew, K Lambrakis, A Blyth, A Seshadri, MJR Edmonds, T Briffa, LA Cullen, S Quinn, J Karnon, A Chuang, AJ Nelson, D Wright, M Horsfall, E Morton, JK French and C Papendick will be published in the journal Circulation (American Heart Association).