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

Nilsson, Staffan; Andersson, Per; Borgqúist, Lars; Grodzinsky, Ewa; Janzon, Magnus; Kvick, Magnus; Landberg, Eva; Nilsson, Håkan; Karlsson, Jan‐Erik

doi:10.1155/2013/532093

Cited by 34 publications

(29 citation statements)

References 14 publications

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“…In a recent study, we found that the emergency referrals of patients with chest pain decreased in PHC centres using POCT-TnT. However, diagnosis of acute myocardial infarctions (AMI) and unstable angina (UA) were occasionally missed among the POCT-TnT users [ 5 ].…”

Section: Introductionmentioning

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

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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.

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Section: Introductionmentioning

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

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“…The availability of a validated CDR, incorporating a PoCT measuring a biomarker of myocardial damage (eg, high-sensitive troponin (hsTn) or heart-type fatty acid binding protein (H-FABP)) is anticipated, however not yet available (Nilsson et al, 2013;Glatz and Mohren, 2013;Glatz and Renneberg, 2014;Willemsen et al, 2014Willemsen et al, , 2015. The majority of GPs expect future PoCTs to be of added value in ruling out ACS (Kip et al, 2017).…”

mentioning

confidence: 99%

Early health technology assessment of future clinical decision rule aided triage of patients presenting with acute chest pain in primary care

Willemsen

Kip²,

Koffijberg³

et al. 2017

Prim Health Care Res Dev

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The objective of the paper is to estimate the number of patients presenting with chest pain suspected of acute coronary syndrome (ACS) in primary care and to calculate possible cost effects of a future clinical decision rule (CDR) incorporating a point-of-care test (PoCT) as compared with current practice. The annual incidence of chest pain, referrals and ACS in primary care was estimated based on a literature review and on a Dutch and Belgian registration study. A health economic model was developed to calculate the potential impact of a future CDR on costs and effects (ie, correct referral decisions), in several scenarios with varying correct referral decisions. One-way, two-way, and probabilistic sensitivity analyses were performed to test robustness of the model outcome to changes in input parameters. Annually, over one million patient contacts in primary care in the Netherlands concern chest pain. Currently, referral of eventual ACS negative patients (false positives, FPs) is estimated to cost €1,448 per FP patient, with total annual cost exceeding 165 million Euros in the Netherlands. Based on 'international data', at least a 29% reduction in FPs is required for the addition of a PoCT as part of a CDR to become cost-saving, and an additional €16 per chest pain patient (ie, 16.4 million Euros annually in the Netherlands) is saved for every further 10% relative decrease in FPs. Sensitivity analyses revealed that the model outcome was robust to changes in model inputs, with costs outcomes mainly driven by costs of FPs and costs of PoCT. If PoCT-aided triage of patients with chest pain in primary care could improve exclusion of ACS, this CDR could lead to a considerable reduction in annual healthcare costs as compared with current practice.

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“…In the study published in 2013 by Nilsson et al [11], samples from 128 patients with chest pain were investigated by POCT-cTnT. However, present study includes samples from 115 of these patients because in 13 cases the blood samples were lost (four due to a broken freezer, nine due to other administrative failures).…”

Section: Methodsmentioning

confidence: 99%

Consequences of high-sensitivity troponin T testing applied in a primary care population with chest pain compared with a commercially available point-of-care troponin T analysis: an observational prospective study

et al. 2015

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BackgroundThere is a demand for a highly sensitive and specific point-of care test to detect acute myocardial infarction (AMI). It is unclear if a high-sensitivity troponin assay will have enough discriminative power to become a decision support in primary care. The aim of this study was to evaluate a high-sensitivity troponin T assay performed in three primary health care centres in southeast Sweden and to compare the outcome with a point-of-care troponin T test.MethodsThis study included 115 patients who consulted their general practitioner for chest pain, dyspnoea on exertion, unexplained weakness and/or fatigue in the last 7 days. Troponin T was analysed by a point-of-care test and a high-sensitivity method together with N-terminal pro-B-type natriuretic peptide (NT-proBNP) and creatinine. All patients were checked for AMI or unstable angina (UA) within 30 days of study enrolment. Univariate and multivariate logistic regression was carried out to examine possible connections between troponin T ≥ 15 ng/L, clinical variables and laboratory findings at baseline. In addition, 21 patients with troponin T ≥ 15 ng/L and no signs of AMI or UA were followed up for 2–3 years.ResultsThree patients were diagnosed with AMI and three with UA. At the ≥ 15 ng/L cut-off, the troponin T method had 100% sensitivity, 75% specificity for AMI and a positive predictive value of 10%. The troponin T point-of-care test missed one case of AMI and the detection limit was 50 ng/L. Troponin T ≥ 15 ng/L was correlated to age ≥65 years (odds ratio (OR), 10.9 95% CI 2.28–51.8) and NT-proBNP in accordance with heart failure (OR 8.62 95% CI 1.61–46.1). Fourteen of the 21 patients, without signs of AMI or UA at baseline, still had increased troponin T at follow-up after 2–3 years.ConclusionsA high-sensitivity troponin T assay could become useful in primary care as a point-of-care test for patients <65 years. For patients older than 65–70 years, a higher decision limit than ≥15 ng/L should be considered and used in conjunction with clinical parameters and possibly with NT-proBNP.

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

Cited by 34 publications

References 14 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

Early health technology assessment of future clinical decision rule aided triage of patients presenting with acute chest pain in primary care

Consequences of high-sensitivity troponin T testing applied in a primary care population with chest pain compared with a commercially available point-of-care troponin T analysis: an observational prospective study

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