O112 How much does a non-physician healthcare worker based model of care for cardiovascular disease management cost?

Abstract

Introduction: In patients with non-ST-elevation acute coronary syndrome (ACS), early risk stratification is of critical importance. Among others, the Thrombolysis in Myocardial Infarction (TIMI) risk score is the most validated and the most extensively used in patients with non-ST-elevation ACS. However, this score does not utilize results of evaluation of early markers of myocardial necrosis such as heart-type fatty acidbinding protein (hFABP). Objectives: The aim of this study was to estimate the effectiveness of new cardiac marker hFABP in the protocol of early risk stratification during rendering emergency medical care for patients with suspected non-ST-elevation acute coronary syndromes (NSTEACS). Methods: The study included two groups of patients. The first group included 442 patients (67 13 years) with suspected NSTEACS who underwent early risk stratification and the second (control group) consist of 491 patients (59 16 years) with suspected NSTEACS but without pre-operative risk stratification. We stratificated patient from first group accordind Modified TIMI risk score which was constructed with included results of hFABP evaluation. This evaluation was provided by a novel, sensitive assay that is based on the immunochromatographic test-strip technique has been recently developed for rapid qualitative detection of hFABP in whole blood (BioTest Co., Novosibirsk, Russia). The procedure requires approximately 100 microliters of whole blood and can be completed within 20 min in any in-patient or out-patient settings without any special equipment. The analytical sensitivity of this test is 15 ng/ml. Results: A preliminary diagnosis of myocardial infarction (MI) was adjudged in 52 (11.8%) patients from the first group and 64 (13.0%) from the second, and a preliminary diagnosis of unstable angina was adjudged in 390 (88.2%) and 427 (87.0%) patients, respectively. The accuracy of diagnosis of myocardial infarction in the first group was higher in the first group than the second (86,5% and 60,9% respectively, p1⁄40,003). The sensitivity of the hFABP assay within the first 12 hours was 84% for the detection of MI and the corresponding specificity was 93%. Conclusion: Using of new cardiac marker hFABP is effective in early risk stratification for patients with suspected non-ST-elevation acute coronary syndromes during rendering emergency medical care. Disclosure of Interest: None Declared