What is it about?
Each year in Europe millions of patients present to hospital and specifically to the casualty department with chest pain. The great challenge has always been to rule out heart attacks and allow safe, early discharge. In the past patients with heart attacks have been discharged inappropriately and have come to harm. There are now much more sensitive markers in the blood that diagnose small heart attacks and do so much earlier compared to several years ago. Secondly there are more defined rules and guidance for doctors in diagnosing and excluding heart attacks. If we are able to diagnose heart attacks early and more importantly rule-out heart attacks and other serious conditions early this would improve care for patients all-round. It would allow earlier treatment for patients with heart attacks but also allow early discharge for those with a heart attack excluded. Importantly this would reduce pressure on casualty departments and allow focus on patients with serious life-threatening conditions. We simply investigated the best way to achieve this.
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Why is it important?
No previous study of this size and with national follow-up of patients, to a year, has investigated simple decision rules and risk scores for early rule-out of heart attack in an all-comers population with chest pain. We have demonstrated that very low levels of troponin and a normal ECG are a very good simple strategy to rule-out heart attacks early. Also we discovered that one risk score (HEART score at a low score) could also be a good guide to allow discharge.
Perspectives
This was a huge team effort to trace everything single patient nationwide and achieve national follow-up. it was great being part of a passionate, idealistic team with lofty ambitions. We wanted to convince our fellow doctors that this was a study they could trust and was close to the reality they were faced with. Ultimately this is a study about numbers. What the acceptable 'miss-rate' for heart attacks is a question not only for doctors or hospital chiefs but for society. We really hope this study can ignite these conversations and improve pathways and decision rules to guide doctors dealing with chest pain who present to casualty
Aleem KHAND
University of Liverpool
Read the Original
This page is a summary of: A direct comparison of decision rules for early discharge of suspected acute coronary syndromes in the era of high sensitivity troponin, European Heart Journal Acute Cardiovascular Care, February 2018, SAGE Publications,
DOI: 10.1177/2048872618755369.
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