Key result
Point-of-care troponin testing is linked to an absolute 18% reduction in primary care emergency referrals.
Why the study?
Does point-of-care Troponin T testing reduce emergency referrals and safely rule out AMI/UA in primary care patients presenting with chest pain?
Observational (n=196)
Yes
Does point-of-care Troponin T testing reduce emergency referrals and safely rule out AMI/UA in primary care patients presenting with chest pain?
While point-of-care troponin testing can reduce emergency healthcare utilization for chest pain, its low sensitivity in primary care settings poses a safety risk of missing acute coronary syndromes.
Answers are grounded in this paper and cite their sources.
POCT-TnT may reduce emergency referrals for chest pain; leaves open its safety in primary care pending prospective trials.
Objective. To investigate the diagnostic accuracy and clinical benefit of point-of-care Troponin T testing (POCT-TnT) in the management of patients with chest pain. Design. Observational, prospective, cross-sectional study with followup. Setting. Three primary health care (PHC) centres using POCT-TnT and four PHC centres not using POCT-TnT in the southeast of Sweden. Patients. All patients ≥35 years old, contacting one of the primary health care centres for chest pain, dyspnoea on exertion, unexplained weakness, and/or fatigue with no other probable cause than cardiac, were included. Symptoms should have commenced or worsened during the last seven days. Main Outcome Measures. Emergency referrals, patients with acute myocardial infarctions (AMI), or unstable angina (UA) within 30 days of study enrolment. Results. 25% of the patients from PHC centres with POCT-TnT and 43% from PHC centres without POCT-TnT were emergently referred by the GP (P = 0.011 ). Seven patients (5.5%) from PHC centres with POCT-TnT and six (8.8%) from PHC centres without POCT-TnT were diagnosed as AMI or UA (P = 0.369). Two patients with AMI or UA from PHC centres with POCT-TnT were judged as missed cases in primary health care. Conclusion. The use of POCT-TnT may reduce emergency referrals but probably at the cost of an increased risk to miss patients with AMI or UA.
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Nilsson et al. (2013) conducted an observational in Chest pain or suspected cardiac symptoms (n=196). Point-of-care Troponin T testing (POCT-TnT) vs. Standard care (primary health care centres not using POCT-TnT) was evaluated on Emergency referrals by the general practitioner (p=0.011). Point-of-care Troponin T testing in primary care reduced emergency referrals compared to standard care, but two cases of acute myocardial infarction or unstable angina were missed.
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