New test set to improve care for patients with suspected heart attack
Manchester researchers have
developed a novel approach, called the Manchester Acute Coronary
Syndromes Decision Rule, to more quickly and effectively diagnose
heart attack in patients admitted to emergency departments.
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. The decision rule has the
potential to safely reduce unnecessary hospital admissions, and
more appropriately allocate time and resource to patients who need
The study published this week in the international,
peer-reviewed medical journal, Heart, indicates that using the
simple decision rule will help doctors to make more accurate
decisions based on a patient's symptoms and the results of simple
blood tests. This could reduce the need for patients to be
unnecessarily admitted to hospital for further tests, and rapidly
identify the highest risk patients, so that they can receive
appropriate treatments more quickly.
The researchers from Manchester Royal Infirmary, Stockport NHS
Foundation Trust, The University of Manchester, and Manchester
Metropolitan University, discovered that the decision rule could
allow more than one in four patients with chest pain to be safely
and immediately discharged from the emergency department. In
contrast, the decision rule also accurately classifies around one
in ten patients with chest pain as 'high risk', enabling them to
receive more intensive treatment at an early stage and to be
treated in a specialist area such as a coronary care unit.
Clinicians have been using the results of blood tests to detect
heart attacks for some time. The most widely used test, which
detects a protein called troponin, can identify nine out of ten
heart attacks when patients first arrive in the emergency
department. However, it can take several hours for troponin
levels to rise in the blood after a heart attack, which means that
many patients are admitted to hospital to wait for later
tests. Most of these later tests show normal results, so the
availability of an accurate test that can be undertaken earlier in
the process has the potential to avoid many unnecessary hospital
The decision rule combines the results of the first troponin
test with levels of another protein that may detect earlier signs
of heart damage: heart-type fatty acid binding protein. It
also takes into account a patient's symptoms and the findings from
the electrocardiogram (ECG), which shows the flow of electricity
through the heart. Using a simple computer program, doctors
can determine from the decision rule the chance that a patient is
having a heart attack. This research found that none of the
patients who were identified by the decision rule as being safe to
discharge from the emergency department had a heart attack.
In contrast, over 95 per cent of the patients in the 'high risk'
category had a heart problem.
Body, Consultant in Emergency Medicine at Manchester Royal
Infirmary and Honorary Lecturer in Cardiovascular Medicine at The
University of Manchester, who led the study said, "This study could
potentially make a huge difference to the way we diagnose heart
attacks and the subsequent treatment options for our patients.
We have now tested the accuracy of
the rule in more than 1100 patients by observing what could have
happened if we'd have used the decision rule instead of providing
our routine care. This study provides the safety and
effectiveness evidence required for us to start using the decision
rule to guide patient care. In the next phase of our work we
will carefully study the potential benefits of the decision rule
for both patients and the NHS".
The delivery of the study was
supported by the National Institute for Health Research (NIHR)
Clinical Research Network, and funding that Dr Body received
through his PhD at Manchester Metropolitan University and,
subsequently, an NIHR Clinical Lecturer grant.
For further information please contact:
0161 701 2679 / 0782 514 2219
0161 701 0260 / 0782 514 2219