A simple blood test could be used to rule out the possibility of heart attack in two-thirds of people who attend A&E with chest pains, report UK researchers.
The test could potentially save the NHS millions of pounds by preventing up to 400,000 unnecessary hospital admissions each year.
As reported in The Lancet, the test measures a protein called troponin, which is released from the heart when a person suffers a heart attack. A low troponin level indicates that a heart attack has not actually occurred, meaning emergency admission, testing and intervention is not necessary and the patient could in fact be cared for at home.
Jeremy Pearson, Medical Director at the British Heart Foundation, says:
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. 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.”
In the UK, around 1 million people visit emergency departments as a result of chest pain. Currently, international guidelines advise that these people are admitted and tested for very high troponin levels, which can involve lengthy hospital stays and repeat testing. However, the test used in the current study is much more sensitive than the standard version, detecting troponin and much lower levels in the blood.
Using this high-sensitivity test, Anoop Shah and team from the University of Edinburgh measured troponin levels in more than 6,000 patients presenting with chest pain at four hospitals in the USA and Scotland. They assessed the negative predictive value (the probability that patients were not actually at risk) of heart attack or death due to a heart condition after 30 days, across a range of troponin concentrations.
They found that a troponin level of <5 ng/L at presentation identified 61% of people who had a very low risk of heart attack, with the threshold having a negative predictive value of 99.6% that persisted regardless of cardiovascular risk factors, age, gender and previous cardiovascular disease.
“Over the last two decades the number of hospital admissions due to chest pain has tripled. The overwhelming majority of these patients do not have a heart attack,” says Shah.
“These findings could dramatically reduce unnecessary hospital admissions and provide substantial cost savings for healthcare providers,” he concludes.