Key result
An accelerated diagnostic chest pain pathway using point-of-care troponin safely identified 61.7% of patients as low-risk, who were managed in rural practice with 0% 30-day MACE (95% CI 0.0-3.3%).
Why the study?
To evaluate the feasibility, acceptability, effectiveness, and safety of an accelerated diagnostic chest pain pathway using point-of-care troponin in rural general practice to identify low-risk patients and avoid unnecessary hospital transfers.
Does an accelerated diagnostic chest pain pathway using point-of-care troponin testing safely reduce hospital transfers in rural patients with suspected ischaemic chest pain?
Observational (n=180)
Yes
Does an accelerated diagnostic chest pain pathway using point-of-care troponin testing safely reduce hospital transfers in rural patients with suspected ischaemic chest pain?
Absolute Event Rate: 0% vs 16.1%
An accelerated diagnostic chest pain pathway using point-of-care troponin in rural general practice is feasible and safely reduces urgent hospital transfers for low-risk patients.
Supports pilot POC troponin pathways in rural practice; leaves open need for larger trials before adoption.
OBJECTIVES: To assess the feasibility and acceptability, and additionally to preliminarily evaluate, the effectiveness and safety of an accelerated diagnostic chest pain pathway in rural general practice using point-of-care troponin to identify patients at low risk of acute myocardial infarction, avoiding unnecessary patient transfer to hospital and enabling early discharge home. DESIGN: A prospective observational pilot evaluation. SETTING: Twelve rural general (family) practices in the Midlands region of New Zealand. PARTICIPANTS: Patients aged ≥18 years who presented acutely to rural general practice with suspected ischaemic chest pain for whom the doctor intended transfer to hospital for serial troponin measurement. OUTCOME MEASURES: The proportion of patients managed using the low-risk pathway without transfer to hospital and without 30-day major adverse cardiac event (MACE); pathway adherence; rate of 30-day MACE; patient satisfaction with care; and agreement between point-of-care and laboratory measured troponin concentrations. RESULTS: A total of 180 patients were assessed by the pathway. The pathway classified 111 patients (61.7%) as low-risk and all were managed in rural general practice with no 30-day MACE (0%, 95% CI 0.0% to 3.3%). Adherence to the low-risk pathway was 95.5% (106 out of 111). Of the 56 patients classified as non-low-risk and referred to hospital, 9 (16.1%) had a 30-day MACE. A further 13 non-low-risk patients were not transferred to hospital, with no events. The sensitivity of the pathway for 30-day MACE was 100.0% (95% CI 70.1% to 100%). Of low-risk patients, 94% reported good to excellent satisfaction with care. Good concordance was observed between point-of-care and duplicate laboratory measured troponin concentrations. CONCLUSIONS: The use of an accelerated diagnostic chest pain pathway incorporating point-of-care troponin in a rural general practice setting was feasible and acceptable, with preliminary results suggesting that it may safely and effectively reduce the urgent transfer of low-risk patients to hospital.
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Norman et al. (2022) conducted an observational in suspected ischaemic chest pain (n=180). Accelerated diagnostic chest pain pathway using point-of-care troponin vs. Non-low-risk patients referred to hospital was evaluated on 30-day major adverse cardiac event (MACE). An accelerated diagnostic chest pain pathway using point-of-care troponin safely identified 61.7% of patients as low-risk, who were managed in rural practice with 0% 30-day MACE (95% CI 0.0-3.3%).
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