Point-of-care testing may expedite movement of patients with ACS from ED to cardiac ward
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Key takeaways:
- A point-of-care troponin test could reduce time patients with a heart attack spend in the ED by nearly 45 minutes.
- The test showed similar 30-day safety compared with testing in a central laboratory.
A bedside cardiac troponin test could reduce the time patients with ACS spend in the ED by nearly 45 minutes, with the availability of a doctor to assess the situation and move them to the cardiac ward, a speaker reported.
The results of the WESTCOR-POC trial were presented at the European Society of Cardiology Congress.
“Emergency departments worldwide are struggling with overcrowding, and this leads to increased mortality, morbidity and costs. Patients investigated with chest pain suspicious for coronary syndrome contribute largely, approximately being 10% of presenting patients,” Kristin M. Aakre, MD, PhD, professor in the faculty of medicine at Haukeland University Hospital in Bergen, Norway, said during a press conference. “Even so, only 5% or 10% of the presenting patients are actually diagnosed with myocardial infarction. ... Most of them have benign conditions and can be discharged.
“There have been several suggestions how to solve this problem. What is currently recommended are accelerated diagnostic protocols where we test the patient when they arrive and 1 hour later we measure the troponin, which is a protein that leaks out into the blood when the myocardial cells are damaged,” Aakre said. “Our question was, could we use a point-of-care bedside test to speed up the logistics?”
For their study, Aakre and colleagues randomly assigned 1,614 patients presenting with suspected ACS at Haukeland University Hospital to bedside point-of-care high-sensitivity cardiac troponin I testing (Atellica VTLi, Siemens Healthineers) or standard care with troponin testing conducted at a central laboratory (Elecsys Troponin T hs STAT, Roche Diagnostics).
Patients were excluded if they required urgent revascularization, had less than 2 months expected survival, were transferred from other hospitals or were unable to provide informed consent.
Baseline characteristics of the participants in each group were similar, with an average age of 61 years and approximately 42% women. Slightly more than one-quarter had a history of atherosclerotic CVD, and slightly less than half had hypertension and hyperlipidemia.
The primary endpoint was ED length of stay. Secondary safety endpoints included total length of stay, discharge within 3 and 6 hours, and a composite of all-cause mortality, acute MI and urgent revascularization within 30 days.
The researchers reported that the average turnaround time for a result from the bedside troponin test was approximately 8 minutes, compared with 60 minutes with the central laboratory.
Overall, the rule-out rate of ACS was 38.6% in the bedside troponin assay group and 64.1% in the standard care group and 51.1% and 28%, respectively, for patients to be put under observation; however, the rule-in rate of non-STEMI diagnosis was similar between the two groups (44% with bedside troponin vs. 48.3% with standard care).
Patients assigned to the point-of-care troponin assay had an average ED stay 6 minutes shorter compared with standard care (174 minutes vs. 180 minutes; P = .024).
ED length of stay decreased further among patients assigned to the bedside troponin assay who were seen by a physician with 60 minutes of ED admission (mean difference, 15 minutes; P < .001) or had a diagnosis of acute MI (mean difference, 43 minutes; P = .005) compared with standard care.
The 30-day incidence of key secondary safety outcomes was low (< 1%) and likelihood of experiencing a 30-day event was not significantly different between the two groups (P = .48).
Length of overall hospital stay was not significantly different between the two groups, nor was percentage discharged within 3 hours and percentage discharged within 6 hours, the researchers found.
“Bedside troponin I testing is efficient and safe; however, you need to consider the whole logistics of your ED to actually achieve the benefit,” Aakre said during the press conference.
“It doesn’t help if you have an 8-minute test if the patient is going to wait 5 hours for the doctor,” she said. “Also, those that had a serious condition, like heart attack, were treated very fast. The nurse sees the blood sample, gets the results immediately and understands that this is a high-risk patient. They will hunt down the doctor and get the patient to the cardiac ward much faster. It’s a small group of patients, but it’s a critically ill group and they need to be handled in the cardiac ward.”
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Aakre KM, et al. Hot line 12. Presented at: European Society of Cardiology Congress; Aug. 30-Sept. 2, 2024; London (hybrid meeting).
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