Getting to the heart of point-of-care testing

Each year, an estimated 360,000 people are admitted to hospital emergency departments suffering from acute chest pain.1 The current standard policy for dealing with patients admitted in these circumstances is to take a troponin measurement on admission and then again 12 hours afterwards2 to rule out acute myocardial infarction (AMI). The standard does vary around the UK, however, with several hospitals taking only one troponin measurement 12 hours after admission. Length of patient stay in hospital is currently one to two days before an accurate diagnosis can be determined. The cost in terms of bed occupancy and inappropriate investigations, therefore, could be reduced if a patient were to receive swift testing and then either rapid discharge or treatment planning. Over the past two years, the Department of Health Services Research, School of Health and Related Research at the University of Sheffield has been carrying out the Random Assessment of Treatment using Panel Assay of Cardiac Markers (RATPAC) trial. This is designed to evaluate the clinical and cost-effectiveness of point-of-care (POC) cardiac marker panels used in the emergency department.

 Reducing patient stay

The RATPAC trial obtained cardiac blood test results quickly and accurately in the accident and emergency (A&E) department at admission. If troponin was present the patient was admitted. If no troponin was detected, the patient was observed and tested again within 90 minutes. This procedure was in contrast to the present use of cardiac markers under current standards, the results of which can take up to 12 hours. Anticipated results will go towards assisting clinicians in defining more rapid care pathways and, in doing so, help to reduce the congestion in the A&E environment and make economic savings for the hospital. Funded by the National Institute for Health Research (NIHR), the RATPAC study is coordinated by a trial manager in Sheffield and a team of experts in fields including emergency medicine, cardiology, pathology, health service research and epidemiology. The project is also supported by leading researchers in the management of chest pain and by nurses working in six A&E departments in hospitals across the UK. The data collection phase of the project is now complete and the study results are expected in December. These will assist in developing greater understanding in this area, which could evolve emergency treatment planning. Patient follow-up is currently being concluded to analyse the effectiveness of POC cardiac testing in A&E. This will look at: • The proportion of patients successfully discharged after assessment in A&E. • Subsequent re-attendance at and/or re-admission to hospital. • Major adverse events such as death, non-fatal AMI and hospitalisation for AMI. • Health and social care costs. • Use of coronary care beds and cardiac treatment.