Introducing new guidelines for diagnosing heart attacks using a blood test could stop heart attacks being missed and save more lives, according to new research funded by us and published in the journal Circulation.
Under current guidelines, people suspected of having a heart attack are tested as soon as they arrive in an Accident and Emergency department, and again after three hours. If levels of a specific protein found in the blood following a heart attack, called troponin, are below the level needed to diagnose a heart attack, this is ruled out and doctors will look for another cause.
Diagnosing a heart attack
However, the researchers say that not all heart attack patients will have a significantly raised troponin level within three hours of presenting at A&E. They found that by identifying very small changes in troponin levels at three hours, compared to those taken immediately after arrival, they were able to more confidently predict whether a person had suffered a heart attack.
The researchers followed 1,218 people who presented at Accident & Emergency complaining of chest pains between 1 June 2013 and 31 September 2015.
When doctors used current clinical guidelines when applying the troponin test, the researchers found that 20 cardiac events (heart attacks or cardiac deaths) were missed, equating to two in every 100 patients tested. However, when the new guidelines were used, only four cardiac events were missed, a reduction of 80 per cent. The researchers have now developed an app to allow clinicians to use this strategy in practice.
The new guidelines were also able to immediately rule out heart attacks in more patients, meaning a higher proportion of people were able to be safely discharged.
Coronary heart disease
Coronary heart disease – the cause of heart attacks - is the UK’s single biggest killer, accounting for nearly 70,000 deaths in the UK each year. When heart muscle is damaged it leaks a molecule called troponin into the bloodstream. Patients suspected of suffering a heart attack will often be given a troponin test to aid diagnosis.
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