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.
Dr 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
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