What question did this study set out to answer?

This trial aims to assess the clinical effectiveness and cost-effectiveness of point-of-care cardiac markers in patients with suspected acute myocardial infarction.

May 1, 2011Health Technology AssessmentOpen Access

The RATPAC (Randomised Assessment of Treatment using Panel Assay of Cardiac markers) trial: a randomised controlled trial of point-of-care cardiac markers in the emergency department

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Why the study?

Does diagnostic assessment using a point-of-care biochemical marker panel increase the proportion of patients successfully discharged home in adults presenting to the ED with suspected acute myocardial infarction?

Population

2,263 adults presenting to hospital emergency departments with chest pain due to suspected but not proven…

Comparison

Diagnostic assessment using a point-of-care… vs Conventional diagnostic assessment without the…

Design

RCT, Allocated using an online randomisation system, Open

Follow-up

3 months

Authors

SGSteve GoodacreUppsala University MBMike BradburnUniversity of Sheffield PFPatrick FitzgeraldStony Brook University

Discussion

Member takes

Implication

Point-of-care testing increases successful ED discharges in suspected AMI; confirms throughput benefit but challenges cost-effectiveness versus standard care.

Key Points

This trial aims to assess the clinical effectiveness and cost-effectiveness of point-of-care cardiac markers in patients with suspected acute myocardial infarction.
Multicentre randomized controlled trial involving 2263 participants with chest pain.
Participants received either point-of-care testing or standard care diagnostic methods.
Primary outcome was successful patient discharge after ED assessment at 4 hours.
32% of the point-of-care group were successfully discharged versus 13% in the standard care group (OR 3.81, 95% CI 3.01-4.82, p < 0.001).
Median length of stay was shorter in the point-of-care group (8.8 hours) compared to standard care (14.2 hours, p < 0.001).
Point-of-care testing was less cost-effective with mean costs per patient of £1217 versus £1006 for standard care (p = 0.056).

Structured PICO

Population

2,263 adults presenting to hospital emergency departments with chest pain due to suspected but not proven acute myocardial infarction, and no other potentially serious alternative pathology or comorbidity. Mean age 54.5 years, 58% male, 12% with known coronary heart disease.

Intervention

Diagnostic assessment using a point-of-care biochemical marker panel (creatine kinase MB, myoglobin, and troponin).

Comparator

Conventional diagnostic assessment without the point-of-care panel (standard care). All tests and treatments other than the panel were provided at the discretion of the clinician.

Outcome

Proportion of patients successfully discharged home after ED assessment, defined as having left the hospital or awaiting transport home with a discharge decision made at 4 hours after initial presentation, and suffering no major adverse event during the following 3 months.composite

Point-of-care testing for cardiac markers in the ED increases the proportion of patients successfully discharged home and reduces median hospital stay, but is more expensive and unlikely to be cost-effective compared to standard care.

Limitations

Slower than anticipated patient recruitment (35% of eligible patients recruited instead of 70%)
Early termination of trial recruitment on the basis of futility for detecting differences in major adverse events

Cite This Study

Goodacre et al. (2011) studied this question.

synapsesocial.com/papers/6a23bdfeb57190d467d375c5 https://doi.org/10.3310/hta15230

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Implication

Point-of-care testing increases successful ED discharges in suspected AMI; confirms throughput benefit but challenges cost-effectiveness versus standard care.

The RATPAC (Randomised Assessment of Treatment using Panel Assay of Cardiac markers) trial: a randomised controlled trial of point-of-care cardiac markers in the emergency department

Discussion

Member takes

Implication

Key Points

Structured PICO

Limitations

Cite This Study

The RATPAC (Randomised Assessment of Treatment using Panel Assay of Cardiac markers) trial: a randomised controlled trial of point-of-care cardiac markers in the emergency department

Discussion

Member takes

Implication

Key Points

Structured PICO

Limitations

Cite This Study

Also Consider

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