General practitioner (GP) cardiac troponin test requesting: findings from a clinical laboratory audit

Sodi, Ravinder; Hine, Trevor; Shenkin, Alan

doi:10.1258/000456307780480800

Cited by 3 publications

(2 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…There is a need for biochemical markers, mainly to rule out AMI and UA in PHC [ 13 ]. However, our study shows that the POCT-TnT kit currently available does not improve the sensitivity of clinical management based on evaluation of the history and clinical signs.…”

Section: Discussionmentioning

confidence: 99%

Cost consequences of point-of-care troponin T testing in a Swedish primary health care setting

Nilsson

Andersson

Janzon

et al. 2014

Scandinavian Journal of Primary Health Care

View full text Add to dashboard Cite

Objective. To evaluate the safety and cost-effectiveness of point-of-care troponin T testing (POCT-TnT) for the management of patients with chest pain in primary care. Design. Prospective observational study with follow-up. Setting. Three primary health care (PHC) centres using POCT-TnT and four PHC centres not using POCT-TnT in south-east Sweden. Patients. All patients ≥ 35 years of age, contacting one of the PHC centres for chest pain, dyspnoea on exertion, unexplained weakness and/or fatigue, with no other probable cause than cardiac, were included. Symptoms must have commenced or worsened during the previous seven days. Main outcome measures. Emergency referral rates, diagnoses of acute myocardial infarction (AMI) or unstable angina (UA), and costs were collected for 30 days after the patient sought care at the PHC centre. Results. A total of 196 patients with chest pain were included: 128 in PHC centres with POCT-TnT and 68 in PHC centres without POCT-TnT. Fewer patients from the PHC centres with POCT-TnT (n = 32, 25%) were emergently referred to hospital than from centres without POCT-TnT (n = 29, 43%; p = 0.011). Eight patients (6.2%) from PHC centres with POCT-TnT were diagnosed with AMI or UA compared with six patients (8.8%) from centres without POCT-TnT (p = 0.565). Two patients with AMI or UA were classified as missed cases from PHC centres with POCT-TnT and there were no missed cases from PHC centres without POCT-TnT. SKr290 000 was saved per missed case of AMI or UA. Conclusion. The use of POCT-TnT in primary care may be cost saving but at the expense of missed cases.

show abstract

Section: Discussionmentioning

confidence: 99%

Cost consequences of point-of-care troponin T testing in a Swedish primary health care setting

Nilsson

Andersson

Janzon

et al. 2014

Scandinavian Journal of Primary Health Care

View full text Add to dashboard Cite

show abstract

“…[ 1 2 3 4 5 6 7 ] Although in most cases the cause of chest pain is known to be a benign condition,[ 2 3 4 6 ] it is a challenge for general practitioners to identify an acutely dangerous cause, such as pulmonary embolism or acute coronary syndrome, but, on the other hand, to avoid unnecessary testing, referrals, and hospital admissions. [ 5 8 9 ] That is why chest pain raises grave concern in both patients and doctors. [ 7 ] A large amount of literature addresses the topic, but the majority focuses on underlying specific conditions or single diseases, such as chronic heart disease, or the data collection is conducted in settings other than general practice.…”

Section: Introductionmentioning

confidence: 99%

Chest pain in general practice: Frequency, management, and results of encounter

Frese

Mahlmeister

Heitzer

et al. 2016

J Family Med Prim Care

View full text Add to dashboard Cite

Objective:Chest pain is a common reason for an encounter in general practice. The present investigation was set out to characterize the consultation rate of chest pain, accompanying symptoms, frequency of diagnostic and therapeutic interventions, and results of the encounter.Materials and Methods:Cross-sectional data were collected from randomly selected patients in the German Sächsische Epidemiologische Studie in der Allgemeinmedizin 2 (SESAM 2) and analyzed from the Dutch Transition Project.Results:Overall, 270 patients from the SESAM 2 study consulted a general practitioner due to chest pain (3% of all consultations). Chest pain was more frequent in people aged over 45 years. The most common diagnostic interventions were physical examination, electrocardiogram at rest and analysis of blood parameters. For the majority of cases, the physicians arranged a follow-up consultation or prescribed drugs. The transition project documented 8117 patients reporting chest pain with a frequency of 44.5/1000 patient years (1.7% of all consultations). Physical examination was also the most common diagnostic intervention, and physician's advice the most relevant therapeutic one.Conclusion:The most common causes for chest pain were musculoskeletal problems followed by cardiovascular diseases. Ischemic heart disease, psychogenic problems, and respiratory diseases each account for about 10% of the cases. However, acutely dangerous causes are rare in general practice.

show abstract

Should general practitioners order troponin tests?

Marshall

Wijeratne

Thomas³

2014

Medical Journal of Australia

View full text Add to dashboard Cite

Cardiac troponin I and T are the preferred biomarkers for assessing myocardial injury, and the timing of troponin testing is fundamental to its clinical utility. There are arguments for and against the use of troponin testing in the community, and the stance that general practitioners should never order a troponin test can be considered an oversimplification. GPs have a generally sufficient understanding of the test for use in primary care, and have a better understanding of false-negative troponin test results than false-positive results. We suggest that hospitalisation, rather than troponin testing, should be the default option for patients with symptoms suggestive of acute coronary syndrome. A single troponin test is reasonable in primary care to exclude the possibility of acute myocardial infarction in asymptomatic low-risk patients whose symptoms resolved at least 12 hours prior. GPs should factor in the complex logistics of troponin testing in the community before ordering a troponin test: results need to be accurate and timely, and might be obtained at a time of day when it is difficult to contact the doctor or the patient.

show abstract

General practitioner (GP) cardiac troponin test requesting: findings from a clinical laboratory audit

Abstract: Address

Cited by 3 publications

References 6 publications

Cost consequences of point-of-care troponin T testing in a Swedish primary health care setting

Cost consequences of point-of-care troponin T testing in a Swedish primary health care setting

Chest pain in general practice: Frequency, management, and results of encounter

Should general practitioners order troponin tests?

Contact Info

Product

Resources

About