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Heart attack patients could be treated more quickly after Manchester research

Clinical judgement, combined with an electrocardiogram (ECG) and blood test on arrival, is effective in reducing unnecessary hospital admissions for chest pain, a new study shows.

The findings of a research group in Manchester, published in the Emergency Medicine Journal, could potentially make a huge difference to a large number of patients.


Chest pain is the most common reason for emergency hospital admission. In Manchester, the incidence of premature death due to heart disease and stroke is amongst the highest in England.

Previous research has shown that typical symptoms in patients presenting to emergency departments have not been useful in differentiating between heart conditions requiring immediate hospital admission (acute coronary syndromes; ACS), and non-cardiac conditions. This is because the symptoms of patients with heart disease can be similar to those experienced by patients with non-cardiac conditions, such as indigestion. However, the role of overall clinical judgement has not been extensively studied.

The latest research, led by Dr Richard Body, Consultant in Emergency Medicine at Manchester Royal Infirmary, assessed the diagnostic accuracy of emergency doctors' clinical judgement for acute coronary syndromes - both alone and in combination with the tests available on arrival - ECG and a blood test which detects a protein called troponin.

The study was undertaken at Stockport NHS Foundation Trust, where doctors in the emergency department recorded their overall clinical judgement for ACS using a five-point Likert scale (from 'definitely ACS' to 'definitely not' ACS). This data was then compared with patients' outcomes, including heart attack or the occurrence of major adverse cardiac events within 30 days.

The results showed that for patients who are suspected to have an ACS, clinical judgement cannot be relied upon by itself to rule out or rule in that diagnosis. However, when combined with an ECG and troponin test clinical judgement appeared to be an effective tool and the results suggest that at least 25 per cent of patient admissions could have been avoided. The study also suggested that this was the case regardless of whether the clinician was a consultant or junior doctor.

Dr Rick Body
Dr Richard Body

Dr Rick Body, who is also National Institute for Health Research Postdoctoral Research Fellow and Honorary Lecturer in Cardiovascular Medicine at The University of Manchester, said: "I think the beauty of this technique is its simplicity. For years we've been working hard to improve our technology and our tests for heart attacks. This research suggests that, if the initial tests are normal and the doctor thinks that the diagnosis of a heart attack is unlikely, it may be perfectly safe to reassure patients that they do not have a heart attack without relying on further tests and observation in hospital.

"It is still early days but the study, which was funded through an NIHR Clinical Lecturer grant and a College of Emergency Medicine Research Grant, could potentially make a huge difference to large numbers of patients. In order to ensure the safety of patients, further research is still vital to ensure that our findings can be repeated with different groups of doctors and patients. We will also need to know if doctors would be confident enough in their judgement to use the technique in practice."

The delivery of the study was supported by the National Institute for Health Research (NIHR) Clinical Research Network.




For further information please contact:

Emma Smith

0161 701 2679 / 0782 514 2219



Lucy Prosser

0161 701 0260 / 0782 514 2219



Notes to Editor

The study was published in Emerg Med J (Body R, Cook G, Burrows G, et al. Emergency Medicine Journal 2014; doi: 10.1136/emermed-2014-203832).

Central Manchester University Hospitals NHS Foundation Trust is a leading provider of specialist healthcare services in Manchester, treating more than a million patients every year. Its eight specialist hospitals (Manchester Royal Infirmary, Saint Mary's Hospital, Royal Manchester Children's Hospital, Manchester Royal Eye Hospital, University Dental Hospital of Manchester and Trafford Hospitals) are home to hundreds of world class clinicians and academic staff committed to finding patients the best care and treatments. (www.cmft.nhs.uk)

The University of Manchester, a member of the prestigious Russell Group of British universities, is the largest and most popular university in the UK. It has 20 academic schools and hundreds of specialist research groups undertaking pioneering multi-disciplinary teaching and research of worldwide significance. According to the results of the 2008 Research Assessment Exercise, The University of Manchester is one of the country's major research institutions, rated third in the UK in terms of 'research power', and has had no fewer than 25 Nobel laureates either work or study there. The University had an annual income of £807 million in 2011/12. (www.manchester.ac.uk)


About the NIHR Clinical Research Network

We provide researchers with the practical support they need to make clinical studies happen in the NHS, so that more research takes place across England, and more patients can take part.

This practical support includes:

  • Reducing the "red-tape" around setting up a study
  • Enhancing NHS resources, by funding the people and facilities needed to carry out research "on the ground"
  • Helping researchers to identify suitable NHS sites, and recruit patients to take part in research studies
  • Advising researchers on how to make their study "work" in the NHS environment


The National Institute for Health Research (NIHR) is funded by the Department of Health to improve the health and wealth of the nation through research. Since its establishment in April 2006, the NIHR has transformed research in the NHS. It has increased the volume of applied health research for the benefit of patients and the public, driven faster translation of basic science discoveries into tangible benefits for patients and the economy, and developed and supported the people who conduct and contribute to applied health research. The NIHR plays a key role in the Government's strategy for economic growth, attracting investment by the life-sciences industries through its world-class infrastructure for health research. Together, the NIHR people, programmes, centres of excellence and systems represent the most integrated health research system in the world. For further information, visit the NIHR website (www.nihr.ac.uk).