A simple blood test can predict whether a patient with chest pain will have a heart attack could save the NHS millions of pounds and reduce the number of people admitted to hospital with a suspected heart attack by more than 50%
About a million people go to A & E or hospital emergency departments every year with chest pains but most will not go on to have a heart attack and go home after a lengthy and stressful stay.
The test looks for a chemical in the blood and results are impressive. From trials on 6304 people an accuracy rate of over 99% was achieved and the test only takes 30 minutes. The test could reduce stress for patients and save money and ease pressure on the NHS.
The Lancet has published a report on a new blood test which could revolutionise the diagnosis of heart attacks and could halve the number of patients admitted. When patients are admitted they are tested for levels of troponin which is a chemical released by damaged heart muscle and then tested again 12 hours later. The new test can detect much lower levels of troponin and usually only needs to be done once so anyone given the all-clear can go straight home.
Dr Atul Anand, one of the researchers and a physician at the Edinburgh Royal Infirmary, said
“It’s really exciting. When you look at patients who come to medical wards with chest pain, 80% are going home 12 hours later.”
“This avoids the hassle, cost and patient stress.”
The test costs less than £10 although not all hospitals currently had the facilities to perform the more sensitive test.
However, Dr Anand said it would be “pretty straightforward” to introduce and there was a “clamouring” to do.
Last year the National Institute for Health and Care Excellence (NICE) recommended the NHS uses the new testing kit but it is unknown when the NHS will move from a double to a single test.
The British Heart Foundation funded the study and are planning a bigger trial of 26,000 people across the UK. They said the test should be rolled out across the NHS. Professor Jeremy Pearson, Associate Medical Director at the British Heart Foundation, said:
“A faster, more accurate diagnosis of whether chest pain is caused by a heart attack would be better for patients and save the NHS money,” said professor Jeremy Pearson from the British Heart Foundation.
“No-one wants to be in hospital unless they have to be.”
“What’s important about this study is that the evidence shows you can quickly and confidently rule out a heart attack without compromising patient safety.”
“We want to ensure no heart attack diagnosis is missed but we equally don’t want to see people go through unnecessary tests and spend extended periods in hospital” he said.
It is thought about 400,000 people could be sent home immediately just be checking for troponin in the heart, saving millions of pounds. Troponin at low levels suggests that a heart attack is unlikely.
“Over the last two decades the number of hospital admissions due to chest pain has tripled but the overwhelming majority of these patients do not have a heart attack,” said lead author Dr Anoop Shah from the University of Edinburgh.
“Until now there were no quick ways to rule out a heart attack within the emergency department.”
“These findings could dramatically reduce unnecessary hospital admissions and provide substantial cost savings for healthcare providers.”
At the moment patients who go to hospital suffering from stabbing chest pains are usually admitted to hospital for tests which can last for more than 24 hours. These tests only check to see whether a heart attack has happened, not if one is imminent.
The researchers found when they checked the blood samples of the people admitted to four hospitals in Scotland and the USA and followed their progress over 30 days the level of troponin was directly linked to whether the patients would go on to have a heart attack.
A person has a high sensitivity troponin-concentration of less than 5 nanograms per litre, was at very low risk of having had a heart attack.
Around 188,000 people suffer heart attacks each year, far fewer than the numbers who arrive at Emergency departments suffering from chest pains.
Dr Atul Anand, a BHF Research Fellow and physician, who co-authored the research at University of Edinburgh and Edinburgh Royal Infirmary, said:
“It can be a devastating blow to learn you’ve had a heart attack. We’d much rather be able to rule this diagnosis out early and prevent unnecessary stress and an overnight stay in hospital.”
“This research has highlighted a quick way to rule out a heart attack in A&E. With further results from this clinical trial we hope to have enough evidence to change clinical guidelines to ensure more accurate diagnosis of heart attacks.”
Symptoms of a heart attack include:
- a dull pain, ache or “heavy” feeling in the chest
- mild discomfort in the chest that makes you feel generally unwell
- pain that spreads to the back, arm or stomach
- pain that feels like bad indigestion
- feeling light-headed or dizzy