Parkland among first in U.S. using new test to diagnose heart attacks faster
Cardiac troponin T-hs assay more precise, quicker
More than 5 million patients visit U.S. hospitals each year complaining of chest pain, but 10 percent of them are actually experiencing a heart attack. Testing blood for cardiac troponin, a protein released from the heart muscle into the blood stream when the heart is damaged, is one of the tools physicians use to help diagnose a myocardial infarction (heart attack) and to rule out other conditions with similar symptoms.
Now a newly approved high sensitivity version of the test (Trop T-hs) is helping to speed diagnosis of heart attack at Parkland Health & Hospital System and a handful of other major medical centers in the nation. The Trop T-hs assay has been used in Europe for a number of years but gained Federal Drug Administration approval for use in the U.S. only in 2016. Parkland is among the first in the U.S., and the only center in Texas, to have implemented the new test, launching its use on Dec. 6, 2017 following months of evaluation for quality, safety and intensive staff training.
Major benefits of the new assay are speed and precision. Parkland found in its pre-implementation test phase that in more than half of patients presenting to the Parkland Emergency Department with chest pain, the high-sensitivity assay allowed doctors to “rule-out” myocardial infarction in just one hour, with 100 percent sensitivity, versus the three to six hours required by the traditional troponin assay.
“Not everyone with a heart attack experiences chest pain or shortness of breath. And conversely, not everyone with chest pain is experiencing a heart attack,” said Sandeep R. Das, MD, MPH, FACC, FAHA, Director of Acute Coronary Care and member of the Parkland Center of High Impact Outcome Studies (PCHICOS) and Associate Professor of Internal Medicine at UT Southwestern Medical Center.
“Patients with chest pain are often kept in hospital emergency departments for many hours, causing unnecessary stress and anxiety for the vast majority who are not having a heart attack, and contributing to ED overcrowding and delays in care,” he added.
Signs and symptoms of heart attack can be the same as those for many other benign conditions, including indigestion, muscle strain or even anxiety, making accurate diagnosis tricky, physicians say. In addition to the troponin blood test, doctors may order EKGs, stress tests and other procedures to help make a diagnosis.
The Trop T-hs assay speeds the process dramatically, allowing clinicians to rule out heart attack diagnosis much faster than was previously possible. “This is obviously a good thing for patients who can be reassured or evaluated and treated for other causes of their symptoms more quickly,” Dr. Das said.
“The improved sensitivity of the new assay enables us to rule out heart attack with a single blood draw for some patients and the improved precision assures we can characterize with a high level of accuracy very small changes in troponin level over short time intervals. The increased sensitivity of the test may also offer new opportunities for us in terms of disease screening and chronic disease monitoring,” he stated.
The faster and more precise test also allows better utilization and stewardship of resources in busy emergency departments like Parkland’s, where high demand for services poses a major challenge.
Parkland has developed an integrated care algorithm to indicate appropriate use of lab tests, EKG, functional tests and other means to improve the standard of care for cardiac patients in conjunction with conversion to the new troponin assay.
“Implementing the new Trop T-hs assay represents a major change in our chest pain management algorithm across the entire institution and required extensive collaboration between nurses, cardiologists, emergency medicine physicians, hospitalists and lab staff,” Dr. Das said. “Moving forward as we gather more data, we will share our experiences in developing new methodology and our clinical results in publications.”
To learn more about services at Parkland hospital, visit www.parklandhospital.com
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