Implementation of rapid rule out of myocardial infarction using high-sensitivity troponin: cross-sectional survey of English hospitals

Thapa, Shabnam; Wong, Ruth; Goodacre, Steve

doi:10.1136/emermed-2019-209100

Cited by 7 publications

(8 citation statements)

References 4 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…No sites used identical strategies; this heterogeneity accords with the findings of a cross-sectional survey of English hospitals and therefore reflects current practice. 19 …”

Section: Methodsmentioning

confidence: 99%

“…No sites used identical strategies; this heterogeneity accords with the findings of a cross-sectional survey of English hospitals and therefore reflects current practice. 19 Clinical management, data collection and follow-up processes are detailed in the supplementary material and in the published protocol. 20…”

Section: Usual Rule-out Strategies (Control)mentioning

confidence: 99%

“…17 18 This may explain why around only 3% of hospitals within the UK use the undetectable cut-off in clinical practice. 19 We aimed to determine whether the LoDED strategy, when used irrespective of chest pain onset time, without risk scores and across different hs-cTn assays, would increase the rate of safe early discharge from hospital in patients with suspected cardiac chest pain, when embedded within routine ED practice, and without an increase in healthcare costs.…”

Section: Introductionmentioning

confidence: 99%

“… 17 18 This may explain why around only 3% of hospitals within the UK use the undetectable cut-off in clinical practice. 19 …”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Limit of detection of troponin discharge strategy versus usual care: randomised controlled trial

Carlton

Ingram

Taylor

et al. 2020

Heart

View full text Add to dashboard Cite

IntroductionThe clinical effectiveness of a ‘rule-out’ acute coronary syndrome (ACS) strategy for emergency department patients with chest pain, incorporating a single undetectable high-sensitivity cardiac troponin (hs-cTn) taken at presentation, together with a non-ischaemic ECG, remains unknown.MethodsA randomised controlled trial, across eight hospitals in the UK, aimed to establish the clinical effectiveness of an undetectable hs-cTn and ECG (limit of detection and ECG discharge (LoDED)) discharge strategy. Eligible adult patients presented with chest pain; the treating clinician intended to perform investigations to rule out an ACS; the initial ECG was non-ischaemic; and peak symptoms occurred <6 hours previously. Participants were randomised 1:1 to either the LoDED strategy or the usual rule-out strategy. The primary outcome was discharge from the hospital within 4 hours of arrival, without a major adverse cardiac event (MACE) within 30 days.ResultsBetween June 2018 and March 2019, 632 patients were randomised; 3 were later withdrawn. Of 629 patients (age 53.8 (SD 16.1) years, 41% women), 7% had a MACE within 30 days. For the LoDED strategy, 141 of 309 (46%) patients were discharged within 4 hours, without MACE within 30 days, and for usual care, 114 of 311 (37%); pooled adjusted OR 1.58 (95% CI 0.84 to 2.98). No patient with an initial undetectable hs-cTn had a MACE within 30 days.ConclusionThe LoDED strategy facilitates safe early discharge in >40% of patients with chest pain. Clinical effectiveness is variable when compared with existing rule-out strategies and influenced by wider system factors.Trial registration numberISRCTN86184521.

show abstract

“…No sites used identical strategies; this heterogeneity accords with the findings of a cross-sectional survey of English hospitals and therefore reflects current practice. 19 …”

Section: Methodsmentioning

confidence: 99%

Section: Usual Rule-out Strategies (Control)mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“… 17 18 This may explain why around only 3% of hospitals within the UK use the undetectable cut-off in clinical practice. 19 …”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Limit of detection of troponin discharge strategy versus usual care: randomised controlled trial

Carlton

Ingram

Taylor

et al. 2020

Heart

View full text Add to dashboard Cite

show abstract

“…The audit showed through a survey that there had been widespread implementation of hsTrop, but there were no data on how the test was being used or whether it was delivering the expected benefits. 10 Therefore, on the basis of this audit, we have no indication of the value of this new test.…”

mentioning

confidence: 95%

Determining value – Do laboratory professionals need to learn more about the ‘dismal science’?

John¹

2020

Ann Clin Biochem

View full text Add to dashboard Cite

RACE-IT – Rapid Acute Coronary Syndrome Exclusion using the Beckman Coulter Access high-sensitivity cardiac troponin I: A stepped-wedge cluster randomized trial

Miller

Cook

Singh-Kucukarslan

et al. 2021

Contemporary Clinical Trials Communications

View full text Add to dashboard Cite

Background Protocols utilizing high-sensitivity cardiac troponin (hs-cTn) assays for the evaluation of suspected acute coronary syndrome (ACS) in the emergency department (ED) have been gaining popularity across the US and the world. These protocols more rapidly rule-out ACS and more accurately identify the presence of acute myocardial injury. At this time, few randomized trials have evaluated the safety and operational impact of these assays, resulting in limited evidence to guide the use and implementation of hs-cTn in the ED. Objective The main study objective is to test the effectiveness of a rapid ACS rule-out pathway using hs-cTnI in safely discharging patients from the ED for whom clinical suspicion for ACS exists. Design This prospective, implementation trial (n = 11,070) will utilize a stepped wedge cluster randomized trial design. The design will allow for all participating sites to capture benefit from the implementation of the hs-cTnI pathway while providing data evaluating the effectiveness in providing safe and rapid evaluation of patients with clinical suspicion for ACS. Summary Demonstrating that clinical pathways using hs-cTnI can be effectively implemented to rapidly rule-out ACS while conserving costly hospital resources has significant implications for the care of patients with possible acute cardiac conditions in EDs across the US. Clinicaltrials.gov identifier NCT04488913.

show abstract

Implementation of rapid rule out of myocardial infarction using high-sensitivity troponin: cross-sectional survey of English hospitals

Cited by 7 publications

References 4 publications

Limit of detection of troponin discharge strategy versus usual care: randomised controlled trial

Limit of detection of troponin discharge strategy versus usual care: randomised controlled trial

Determining value – Do laboratory professionals need to learn more about the ‘dismal science’?

RACE-IT – Rapid Acute Coronary Syndrome Exclusion using the Beckman Coulter Access high-sensitivity cardiac troponin I: A stepped-wedge cluster randomized trial

Contact Info

Product

Resources

About