Study protocol for an observational study to evaluate an accelerated chest pain pathway using point-of-care troponin in New Zealand rural and primary care populations

Abstract

INTRODUCTIONAccelerated diagnostic chest pain pathways are used widely in urban New Zealand hospitals. These pathways use laboratory-based troponin assays with good analytical precision. Widespread implementation has not occurred in many of New Zealand’s rural hospitals and general practices as they are reliant on point-of-care troponin assays, which are less sensitive and precise. An accelerated chest pain pathway using point-of-care troponin has been adapted for use in rural settings. A pilot study in a low-risk rural population showed no major adverse cardiac events at 30 days. A larger study is required to be confident that the pathway is safe. AIMSTo assess the safety and effectiveness of an accelerated chest pain pathway adapted for rural settings and general practice using point-of-care troponin to identify low-risk patients and allow early discharge. METHODSThis is a prospective observational study of an accelerated chest pain pathway using point-of-care troponin in rural hospitals and general practices in New Zealand. A total of 1000 patients, of whom we estimate 400 will be low risk, will be enrolled in the study. OUTCOME MEASURESThe primary outcome is the proportion of patients identified by the pathway as low risk for a 30-day major adverse cardiac event. Secondary outcomes include the proportion of low-risk patients who were discharged directly from general practice or rural hospitals, the proportion of patients reclassified as having acute myocardial infarction by the pathway and the proportion of patients with low and intermediate risk safely managed in the rural hospital.

Implementation and evaluation of a rural general practice assessment pathway for possible cardiac chest pain using point-of-care troponin testing: a pilot study

“…A prospective observational evaluation is currently underway to verify the safety and efficacy of the pathway using POC-cTn to identify low-risk patients and allow their early discharge from rural hospitals or directly from general and urgent care practices in NZ. 30 In this we hope to recruit 1000 patients with suspected cardiac chest pain. Safety will be determined by measuring the proportion of 30-day MACE.…”

“…Although the NPV of the ADP for 30-day MACE was 100%, a larger study is required to verify the pilot study findings and allow the NZ Cardiac Network to endorse the use of an ADP using POC-cTn in rural communities into its national policy. A prospective observational evaluation is currently underway to verify the safety and efficacy of the pathway using POC-cTn to identify low-risk patients and allow their early discharge from rural hospitals or directly from general and urgent care practices in NZ 30. In this we hope to recruit 1000 patients with suspected cardiac chest pain.…”

Implementing “Chest Pain Pathway” Using Smartphone Messaging Application “WhatsApp” as a Corrective Action Plan to Improve Ischemia Time in “ST-Elevation Myocardial Infarction” in Primary PCI Capable Center “WhatsApp-STEMI Trial”

“…Additionally, it can improve resources utilization like reduction of length of stay and unnecessary hospital admissions. [14][15][16][17][18][19][20] Constant feedback with a closed-loop debriefing for each case using different means of communication is known to improve outcomes. [21][22][23][24][25][26][27][28] The use of WhatsApp (a smartphone messaging application) was already reported in the literature for quality improvement in multiple studies for telemedicine, emergency room disposition, and guidelines compliance.…”

“…Additionally, it can improve resources utilization like reduction of length of stay and unnecessary hospital admissions. 14–20…”