Patients with chest pain do not always need to be taken to the emergency room by ambulance. If there is little risk of a heart attack, paramedics can safely treat these people at home. This is shown by research by the RadboudUMC in Nijmegen, which was published on Friday in the European Heart Journal.
Every year, about 200,000 ambulances are dispatched to drive people with chest pain to the emergency room. In 8 to 9 out of 10 of these people, it turns out in the hospital that there is nothing wrong with the heart. Gelderland cardiologists wanted to find out whether these patients could be safely examined at home with a simple blood test, so that only people who are at high risk of a heart attack are taken to hospital.
Ambulance services from five Dutch regions participated in the study. After a call from a patient with chest pain, the rushed employees first assessed the risk of heart problems based on the symptoms, age, risk factors such as a previous vascular problem or, for example, high blood pressure, diabetes or obesity, and on the result of a electrocardiogram (ECG) or a heart film.
Cost
If there was a high risk of a heart attack, a patient went straight to the hospital. If the risk was low (3 points or less out of a potential risk score of 8 points), fate determined whether the patient was driven to the emergency room, or tested at home. A total of 863 of these low-risk patients participated in the study.
In the people who were first treated at home, the paramedics did a blood test to determine the concentration of tropinin T. This is a protein that is produced when there is heart damage, and its concentration in the blood is an indication of an imminent heart attack. Normally, the level of tropinin in the blood is determined in the emergency room. The ambulance personnel could easily measure the concentration of troponin T in the blood with a test strip that gave a result after 12 minutes.
If the concentration of troponin T rose above a certain value, the patient still went to the emergency room. If the concentration was low, the patient could stay at home. These people were given instructions on when to call their GP.
The researchers investigated who had suffered a heart attack or other heart problem or died in the thirty days following the ambulance call. The chance of this was very small and hardly differed between the group kept at home (0.5 percent) and the group in which a low troponin level was measured in the emergency room (1 percent). In the group as a whole, it occurred in 17 of 434 patients who were first assessed at home (and referred as high risk), and in 16 of 429 patients who were driven directly to the emergency room.
The researchers also calculated the cost savings if people were first tested at home: more than 600 euros per patient. On an annual basis, it would save 48 million euros if this approach were introduced throughout the Netherlands, the authors calculated.
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