2nd October 2014
Blood test offers fast diagnosis or rule-out of heart attack for A&E patients with chest pain
National Institute for Health and Care Excellence (NICE) recommends a test to rule out heart attack in patients within three hours of arriving at A&E, with the potential to reduce time in hospital and save the NHS up to £60m
New NICE guidance recommends a blood test (Roche Diagnostics’ Elecsys Troponin T hs) which allows healthcare professionals to quickly rule out heart attack in patients attending A&E with chest pain, and consider alternative diagnosis at an earlier stage.
Current tests to diagnose or rule out heart attack use assessment protocols that take 10 – 12 hours,  meaning a prolonged stay in hospital for patients under assessment which can cause unnecessary anxiety, delay potentially life-saving treatment decisions, and incur higher treatment costs for hospitals.
The Elecsys Troponin T hs test is up to 100 times more sensitive than currently used cardiac troponin tests.  Data suggests that it can rule out heart attack in 60% of patients and confirm heart attack in 17% of patients within one hour of admission.  This means 77% of patients may avoid the need for prolonged monitoring once a heart attack is confirmed or ruled out.
Approximately 700,000 people go to A&E with chest pain in England and Wales each year. For over 300,000 of these, measurement of cardiac troponin – a substance which indicates damage to the heart – is needed to confirm whether or not they’re having a heart attack.  Cardiac troponin is released when blood flow to the heart is reduced or blocked for a significant amount of time (around 30–60 minutes).
This test may lead to earlier diagnosis, reduction in hospital time for patients – which may also reduce bed-blocking – and less anxiety for patients who will be able to get the treatment they need much faster than with current tests.
The Elecsys test could save £200 for each of the 300,000 patients who would benefit from its use in diagnosis,  meaning a potential saving for the NHS of £60million per year.
Dr Richard Body, NIHR Postdoctoral Research Fellow, Consultant in Emergency Medicine and Honorary Lecturer in Cardiovascular Medicine, Manchester Royal Infirmary, says: "Today, we have a clear and urgent problem with the diagnosis of non-ST elevation myocardial infarction* in the emergency department. Patients are routinely admitted to hospital for serial biomarker testing even though only a minority actually has the diagnosis we suspect. In Manchester, high sensitivity troponin assays have enabled us to identify patients with non-ST elevation myocardial infarction much earlier and much better than ever before.
“The new NICE recommendations provide practical guidance to clinicians that will help to reduce the duration of serial testing in a safe and cost-effective manner. This positive move will greatly help to alleviate the burden on the NHS and to reduce the inconvenience and risks associated with unnecessary hospital admissions."
Symptoms of heart attack include chest pain, feeling lightheaded or dizzy, shortness of breath, feeling sick, coughing or wheezing, and having an overwhelming sense of anxiety. If you believe someone is having a heart attack, dial 999 and request an ambulance immediately.
For more information about the Elecsys Troponin T high sensitive test, visit: http://www.roche.com/products/product-details.htm?type=product&id=222
For more information about heart attacks, visit NHS Choices: http://www.nhs.uk/Conditions/Heart-attack/Pages/Symptoms.aspx
1. Nice Clinical Guideline 95. March 2010. http://www.nice.org.uk/guidance/cg95
2. Reichlin T et al. Arch Intern Med 2012: 10:172(16):1211-8
3. National Institute for Health and Care Excellence. Diagnostics Guidance. Myocardial infarction (acute): Early rule out using high-sensitivity troponin tests (Elecsys Troponin T high-sensitive, ARCHITECT STAT High Sensitive Troponin-I and AccuTnl+3 assays). October 2014. http://www.nice.org.uk/guidance/dg15
4. Westwood ME et al. A Diagnostic Assessment Report. Kleijnen Systematic Reviews Ltd, 2014
Notes to Editors
* Doctors separate heart attacks (also known as myocardial infarctions) into two main types. These are ST-segment elevation myocardial infarctions (STEMIs), and non-ST segment elevation myocardial infarctions (NSTEMIs). STEMI can be diagnosed using an electrocardiogram, but diagnosis of NSTEMI is more challenging. Damage to heart muscle cells caused by reduced blood flow during a heart attack leads to the release of a protein called cardiac troponin. Changes in troponin levels can, therefore, help distinguish NSTEMI from other conditions with similar symptoms, such as unstable angina. NSTEMI is only one cause of increased troponin; however, so clinical judgement and assessment are also needed to rule out other causes (such as myocarditis (inflammation of the heart), congestive heart failure, severe infections and kidney disease).
Headquartered in Basel, Switzerland, Roche is a leader in research-focused healthcare with combined strengths in pharmaceuticals and diagnostics. Roche is the world’s largest biotech company, with truly differentiated medicines in oncology, immunology, infectious diseases, ophthalmology and neuroscience. Roche is also the world leader in in vitro diagnostics and tissue-based cancer diagnostics, and a frontrunner in diabetes management. Roche’s personalised healthcare strategy aims at providing medicines and diagnostics that enable tangible improvements in the health, quality of life and survival of patients. Founded in 1896, Roche has been making important contributions to global health for more than a century. Twenty-four medicines developed by Roche are included in the World Health Organization Model Lists of Essential Medicines, among them life-saving antibiotics, antimalarials and chemotherapy.
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