Use In Cardiac Triage

Heart disease is a global problem, with around 23 million presentations to emergency departments each year, accounting for approximately 5% of all emergency visits in the UK.

The management of chest pain has not changed significantly over the last 30 years and each patient must be assumed to be experiencing, or at risk of, an imminent MyocardiaI Infarct (MI) or Heart Attack until proven otherwise.

Even so, additional studies show that between 2% and 8% of patients are discharged from emergency rooms inappropriately with an undiagnosed MI. All of the major guidelines dealing with patients presenting with chest pain, those published by the American Heart Association, European Society of Cardiology and the UK NICE,  are broadly similar and rely on a series of tests designed to confirm (or ‘rule-in’) damage to the heart tissue. These routinely include ECG and blood tests to determine any increase in the levels of the protein troponin. Troponin is released as a direct result of injury to the heart muscle, but can take up to 12 hours subsequent to the onset of chest pain to be diagnostic.

Based on scientific literature, it is estimated that up to 75% of patients who present at the emergency department with chest pain have a non-cardiac condition, but many of these will still go through the complete triage process. In addition, in patients who have had or are having a cardiac event, it has been proven in various studies that the longer a patient waits for treatment (typically primary percutaneous coronary intervention [PPCI]) following the onset of chest pain the worse their eventual outcome will be.