This saves hassle for the patient, puts pressure on the emergency department and is expected to cost tens of millions of euros per year.
New method
In the Netherlands, 200,000 patients with chest pain report annually to the Eerste Harthulp, the emergency department for people with possible heart conditions. The protocols of GPs and ambulance staff, for example, are fine-tuned: chest pain can indicate a heart attack, a life-threatening condition that requires urgent action. In the hospital, however, it appears that little is wrong with 80 to 90 percent of the patients. In an article in the European Heart Journal cardiologist Cyril Camaro and colleagues therefore propose a new way of working.
Nearly 900 people with chest pain participated in the study. Paramedics assessed their risk of a heart problem based on symptoms, age, risk factors and an ECG. With a high risk of a heart attack, a patient immediately went to the hospital. In the case of a low risk, the paramedics analyzed the amount of troponin (protein that is released during heart damage) in the blood. If the level of troponin was low, the patient stayed at home, with further instructions such as contact with the GP. All patients were followed up to 30 days after the event. The researchers wanted to know whether a major heart problem, such as a heart attack, still occurred during that period.
48 million savings
The risk of a heart attack was very small. In the patient group who stayed at home with a low troponin level, a major heart problem occurred in 0.5 percent of the cases, in the group who still went to hospital with a low troponin level, this was 1 percent. Doctor-researcher Joris Aarts: “Patients with a low risk of a heart attack can generally stay at home safely. This is good news, because an emergency ambulance ride and hospitalization are major events. Now we know that it is often not necessary.”
In addition, this new analysis reduces healthcare costs at the patient’s home. The researchers calculated that it saves more than 600 euros per patient if they do not have to go to the hospital. Cardiologist and principal researcher Cyril Camaro: “If we introduce this throughout the Netherlands, this will save up to 48 million euros on an annual basis. The Integral Care Agreement emphasizes more efficient care. We all play a part in this.”
National rollout
Camaro will focus on implementing this project in the coming years. A national consortium recently came together, comprising all Dutch research groups that are involved in assessing a patient before he or she is admitted to hospital. Strict monitoring and proper education and training are crucial for the national roll-out of this new strategy. In some of the patients with chest pain, the high-risk patients, it is not yet clear whether this strategy works well. A national follow-up study is desirable, says Radboudumc.