News Release

New 2-hour protocol identifies patients admitted with chest pain who are at low risk of a serious cardiac event, and thus may be discharged from hospital earlier

ASPECT study

Peer-Reviewed Publication

The Lancet_DELETED

A new protocol for rapid identification of patients admitted with chest pain who are at low risk of having a serious cardiac event is published in an Article Online First and in an upcoming Lancet. Thus these patients could potentially be discharged earlier, reducing costs and freeing the emergency department for other emergency patients. The Article is by Dr Martin Than, Department of Emergency Medicine, Canterbury District Health Board, Christchurch, New Zealand, and colleagues.

Every year, an estimated 5-10% of presentations to emergency departments, and up to a quarter of hospital admissions are attributable to symptoms suggestive of acute coronary syndromes (eg, heart attacks). Yet most patients with symptoms suggestive of acute coronary syndromes undergo lengthy assessment, either in the emergency department or as hospital inpatients, even though 75-85% of these patients ultimately do not have a final diagnosis of acute coronary syndromes. In this study, the authors aimed to create a reliable, reproducible, and fast process to identify patients presenting with chest pain who have a low short-term risk of a major adverse cardiac event. They consider such a process is needed to facilitate early discharge of these patients.

This observational study was undertaken in 14 emergency departments in nine countries* in the Asia-Pacific region, in patients aged 18 years and older with at least 5 min of chest pain. The accelerated diagnosis protocol (ADP) included use of a structured pre-test probability scoring method (Thrombolysis in Myocardial Infarction [TIMI] score), electrocardiograph (ECG), and point-of-care biomarker tests of troponin, creatine kinase MB, and myoglobin. If all parts of the ADP were negative then patients were classified as being at low-risk of a major cardiac event

3582 consecutive patients were recruited and completed 30-day follow-up. The ADP classified 352 (9•8%) patients as low risk and potentially suitable for early discharge. A major adverse cardiac event subsequently occurred in three (0•9%) of these patients, making the new protocol 99% accurate.

The authors conclude: "Findings from this large, multinational study have prospectively validated that a 2-h accelerated diagnostic protocol, with use of point-of-care biomarkers, ECG, and TIMI score, can safely identify patients at very low short-term risk of a major adverse cardiac event. These patients could potentially be discharged several hours earlier to outpatient follow-up and further investigations than with present practices…The components needed for the implementation of this strategy are widely available. The ADP has the potential to affect health-service delivery worldwide."

In a linked Comment, Dr Richard Body, Cardiovascular Sciences Research Group, University of Manchester, UK, says: "ASPECT has successfully established that an accelerated diagnostic protocol incorporating triple marker testing successfully identifies a group of patients at very low risk of major adverse cardiac events who could reasonably be considered for early discharge."

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Dr Martin Than, Department of Emergency Medicine, Canterbury District Health Board, Christchurch, New Zealand. T) +64 21450685 E) martinthan@xtra.co.nz

Dr Richard Body, Cardiovascular Sciences Research Group, University of Manchester, UK. T) +44 (0)7880 712 929 (mobile) E) richard.body@manchester.ac.uk

Notes to editors:
*9 countries: New Zealand, Australia, Singapore, China, India, Taiwan, Thailand, South Korea, Indonesia.


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