Accelerated pathway in the assessment of suspected acute coronary syndrome in the Emergency Department: a diagnostic accuracy study.

Chest pain is one of the most common conditions treated in the Emergency Department (ED), but making a diagnosis remains challenging and resource-intensive. Not all causes of chest pain are due to heart disease. Currently, doctors do a blood test to look for the presence of a cardiac chemical called Troponin I to assist them in making a diagnosis of heart disease. This chemical is released from heart muscles when they are damaged and is, therefore, a good indicator of heart attack. However, because Troponin I is released slowly, doctors have to wait for up to six hours to determine whether it is present in the blood.

This project hopes to make a more rapid diagnosis of the patient’s chest pain by measuring several different heart hormones and chemicals two hours after an individual presents to the ED. These chemicals are known as creatine kinase-MB-isoenzyme (CK-MB), B-type natruiretic peptide (BNP), and myoglobin.

This project will recruit 1000 consecutive patients presenting to the Royal Brisbane Emergency Department with greater than 5 minutes chest pain. Patients will be managed and investigated as per standard care. However, additional blood test will be taken at two hours to assess the combination of heart chemicals. Later there will be follow-up on patients to determine whether the two hour test was accurate in diagnosing heart attack.

Validating the Manchester Acute Coronary Syndromes (MACS) Clinical Decision Rule

Diagnosis of heart attack (acute myocardial infarction) relies on troponin testing along with additional inpatient investigations. Researchers in the United Kingdom have developed a clinical decision rule (the MACS rule) for avoiding unnecessary hospitalisation for patients with chest pain. The MACS rule places individuals into four risk groups with suggested dispositions for each group, with the very low risk eligible for immediate discharge. Initial validation of the rule revealed that 31.5% of patients met the low risk criteria and so could be discharged from hospital with no further investigation. Of these patients, none had a heart attack within 30 days.
This study will conduct an external validation of the MACS rule using a sample of 1000 patients who presented to the Royal Brisbane and Women’s Hospital emergency department with chest pain. If the MACS rule accuracy identifies a group of patients who do not have a heart attack, it could be used in clinical care to rapidly rule out heart attack, decrease resource utilisation and ensure that patients are not subjected to unnecessary testing in hospital.

Basel Syncope Evaluation Study: BASEL IX Study

Management of patients with syncope (loss of consciousness) is a serious problem concerning 1 - 2 per cent of Emergency Department presentations. Of these, it is known that between six and 20 per cent of patients will have a problem with their heart. The rapid and accurate identification of patients with cardiac related syncope is an important clinical need which until this time has not been met.

This observational study will evaluate the diagnostic value of patients’ history, clinical judgement and new blood tests (biomarkers) for cardiac syncope. The study will recruit 720 adult patients across multiple sites internationally. Eligibility will be aged based, for those 40 years and older, and presenting to the ED with syncope. The EMF grant was awarded to fund the Queensland portion that will recruit 60 adult patients of this larger international study that includes a two year follow up.