Point-of-Care Troponin T Testing in the Management of Patients with Chest Pain in the Swedish Primary Care

Ewa Grodzinsky,Lars Borgquist,Jan-Erik Karlsson,Per O Andersson,Eva Landberg,Magnus Kvick,Håkan Nilsson,Magnus Janzon,Staffan Nilsson

doi:10.1155/2013/532093

Abstract

Objective. To investigate the diagnostic accuracy and clinical benefit of point-of-care Troponin T testing (POCT-TnT) in the management of patients with chest pain. Design. Observational, prospective, cross-sectional study with followup. Setting. Three primary health care (PHC) centres using POCT-TnT and four PHC centres not using POCT-TnT in the southeast of Sweden. Patients. All patients ≥35 years old, contacting one of the primary health care centres for chest pain, dyspnoea on exertion, unexplained weakness, and/or fatigue with no other probable cause than cardiac, were included. Symptoms should have commenced or worsened during the last seven days. Main Outcome Measures. Emergency referrals, patients with acute myocardial infarctions (AMI), or unstable angina (UA) within 30 days of study enrolment. Results. 25% of the patients from PHC centres with POCT-TnT and 43% from PHC centres without POCT-TnT were emergently referred by the GP (P = 0.011 ). Seven patients (5.5%) from PHC centres with POCT-TnT and six (8.8%) from PHC centres without POCT-TnT were diagnosed as AMI or UA (P = 0.369). Two patients with AMI or UA from PHC centres with POCT-TnT were judged as missed cases in primary health care. Conclusion. The use of POCT-TnT may reduce emergency referrals but probably at the cost of an increased risk to miss patients with AMI or UA.

Highlights

Chest pain is a frequent complaint in primary health care and a daily diagnostic challenge to the general practitioner (GP). e outcome of GPs’ diagnostic capability has been investigated and clinical decision rules have been suggested based on history, symptoms, signs, and electrocardiogram ndings [1,2,3,4,5]
Seven patients (5.5%) from primary health care (PHC) centres with POCTTnT were diagnosed with acute myocardial infarction (AMI) or unstable angina (UA) compared to six patients (8.8%) from centres without point of care test (POCT)-TnT (PP P PPPPP), (Table 3)
In all these 13 cases, the time between onset of symptoms to examination by the GPs in the PHC centres was at least 10 hours

Summary

Introduction

Chest pain is a frequent complaint in primary health care and a daily diagnostic challenge to the general practitioner (GP). e outcome of GPs’ diagnostic capability has been investigated and clinical decision rules have been suggested based on history, symptoms, signs, and electrocardiogram ndings [1,2,3,4,5]. Chest pain is a frequent complaint in primary health care and a daily diagnostic challenge to the general practitioner (GP). E outcome of GPs’ diagnostic capability has been investigated and clinical decision rules have been suggested based on history, symptoms, signs, and electrocardiogram ndings [1,2,3,4,5]. Support from POCT-TnT may reduce referrals to the emergency room, but on the other hand a very recent AMI or unstable angina (UA) may be overlooked if the GPs rely too much on a laboratory nding. E aim of this study was to investigate the diagnostic accuracy and clinical bene t of POCT-TnT in the management of patients with chest pain in a primary health care setting

Methods

Results

Conclusion