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A&E doctor leads trial of new 'heart attack detection' system

A doctor who has developed a new method for assessing whether patients arriving at A&E with chest pain have in fact suffered a heart attack has been awarded a £467,000 National Institute for Health Research (NIHR) Postdoctoral Fellowship to test the method at two local hospitals.

Accident and EmergencyDr Richard Body, a consultant in emergency medicine at Manchester Royal Infirmary (MRI), has pioneered the Manchester Acute Coronary Syndromes (MACS) decision rule to help A&E staff decide if someone needs to be admitted and treated for a heart attack.  When patients visit A&E with chest pains, doctors often recommend that they are admitted to hospital for tests to rule out a heart attack.  Although this is the most common reason for hospital admission, most of these patients do not actually have a heart attack.  Hospital admission could have been avoided if better tests had been available in A&E.  Unnecessary admissions are worrying and inconvenient for patients and also an inefficient use of hospital resources.

The NIHR has awarded Dr Body a five-year fellowship and funding to carry out an initial trial of the MACS rule in the Emergency Departments at MRI and Salford Royal.  Beginning in early 2013, patients attending the two hospitals with pain in the chest, neck, jaw or arms which could be a symptom of a heart attack will be able to participate in the trial. Their outcomes will be compared with those of patients who receive the standard tests for suspected cardiac chest pain.

"The MACS rule combines symptoms reported by the patient with ECG findings and tests for chemicals called troponin and heart-type fatty acid binding protein, which are present in the blood when a heart attack occurs," explained Dr Body, who is also an honorary lecturer in cardiovascular medicine at The University of Manchester.  "It then assigns patients to one of four risk groups, which enables A&E staff to give them the most appropriate treatment according to the likelihood that they have had a heart attack.

"Those in the 'no risk' group can be discharged and followed up within 72 hours.  The 'low risk' patients can be monitored on an observation ward, and discharged if their blood tests are normal.  The 'medium risk' group will be admitted to a hospital ward, while the 'high risk' group will go to a specialist coronary care unit.

"We worked with over 700 patients initially to gather information and develop the MACS rule, and found that 35.5% could have been discharged because they had not suffered a heart attack. The trial will now help us to gauge the views of patients and clinical staff about using MACS, and to check the high accuracy levels of MACS are maintained as more people use it."

Participants in the MACS trial will be followed up by doctors and research nurses in a special clinic after 72 hours and then by telephone after 30 days, three and six months.  All the information gathered will be stored in a website managed by the independent Glasgow Clinical Trials Unit, which will also report on the outcome of the initial trial and whether a much larger trial across the NHS is feasible.

"Coronary heart disease can affect adults of any age, and is the leading single cause of death in the western world," added Dr Body.  "By quickly identifying people whose chest pain is not caused by a heart attack, we can ensure specialist staff and facilities are available for the heart disease patients who need them.  If the MACS rule remains very accurate in assessing risk following a larger trial, we could potentially roll it out across the whole NHS, and ultimately make it available worldwide."