Abstract
BackgroundEvidence of the clinical benefit of 3-in-1 point-of-care testing (POCT) for cardiac troponin T (cTnT), N-terminal pro-brain natriuretic peptide (NT-proBNP) and D-dimer in cardiovascular risk stratification at primary care level for diagnosing acute coronary syndromes (ACS), heart failure (HF) and thromboembolic events (TE) is very limited. The aim of this study is to analyse the diagnostic accuracy of POCT in primary care.MethodsProspective multicentre controlled trial cluster-randomised to POCT-assisted diagnosis and conventional diagnosis (controls). Men and women presenting in 68 primary care practices in Zurich County (Switzerland) with chest pain or symptoms of dyspnoea or TE were consecutively included after baseline consultation and working diagnosis. A follow-up visit including confirmed diagnosis was performed to determine the accuracy of the working diagnosis, and comparison of working diagnosis accuracy between the two groups.ResultsThe 218 POCT patients and 151 conventional diagnosis controls were mostly similar in characteristics, symptoms and pre-existing diagnoses, but differed in working diagnosis frequencies. However, the follow-up visit showed no statistical intergroup difference in confirmed diagnosis frequencies. Working diagnoses overall were significantly more correct in the POCT group (75.7% vs 59.6%, p = 0.002), as were the working diagnoses of ACS/HF/TE (69.8% vs 45.2%, p = 0.002). All three biomarker tests showed good sensitivity and specificity.ConclusionPOCT confers substantial benefit in primary care by correctly diagnosing significantly more patients.Trial registrationDRKS: DRKS00000709
Highlights
Evidence of the clinical benefit of 3-in-1 point-of-care testing (POCT) for cardiac troponin T, N-terminal pro-brain natriuretic peptide (NT-proBNP) and D-dimer in cardiovascular risk stratification at primary care level for diagnosing acute coronary syndromes (ACS), heart failure (HF) and thromboembolic events (TE) is very limited
Characteristics and blood parameters were similar in both groups (Table 1)
The interval between symptom onset and baseline visit was much longer in the POCT group because some patients presented over 5 days after symptom onset
Summary
Evidence of the clinical benefit of 3-in-1 point-of-care testing (POCT) for cardiac troponin T (cTnT), N-terminal pro-brain natriuretic peptide (NT-proBNP) and D-dimer in cardiovascular risk stratification at primary care level for diagnosing acute coronary syndromes (ACS), heart failure (HF) and thromboembolic events (TE) is very limited. Tightness, pressure or squeezing, along with dyspnoea and heartburn-like sensations, are a diagnostic challenge in primary care medicine. Common causes of chest pain and dyspnoea include stable angina, gastrointestinal disease, panic disorder, viral infection and musculoskeletal pain, but the most serious suspects include acute coronary syndromes (ACS), heart failure (HF) and thromboembolic events (TE) [1,2,3]. Cardiac troponin T (cTnT), N-terminal probrain natriuretic peptide (NT-proBNP) and D-dimer are the most used, in particular for cardiovascular risk stratification [5].
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