Limit of detection of troponin discharge strategy versus usual care: randomised controlled trial
dc.contributor.author | Carlton, EW | |
dc.contributor.author | Ingram, J | |
dc.contributor.author | Taylor, H | |
dc.contributor.author | Glynn, J | |
dc.contributor.author | Kandiyali, R | |
dc.contributor.author | Campbell, S | |
dc.contributor.author | Beasant, L | |
dc.contributor.author | Aziz, S | |
dc.contributor.author | Beresford, P | |
dc.contributor.author | Kendall, J | |
dc.contributor.author | Reuben, A | |
dc.contributor.author | Smith, JE | |
dc.contributor.author | Chapman, R | |
dc.contributor.author | Creanor, S | |
dc.contributor.author | Benger, JR | |
dc.date.accessioned | 2020-05-13T12:13:07Z | |
dc.date.issued | 2020-05-05 | |
dc.description.abstract | Introduction The clinical effectiveness of a ‘rule-out’ acute coronary syndrome (ACS) strategy for emergency department patients with chest pain, incorporating a single undetectable high-sensitivity cardiac troponin (hs-cTn) taken at presentation, together with a non-ischaemic ECG, remains unknown. Methods A randomised controlled trial, across eight hospitals in the UK, aimed to establish the clinical effectiveness of an undetectable hs-cTn and ECG (limit of detection and ECG discharge (LoDED)) discharge strategy. Eligible adult patients presented with chest pain; the treating clinician intended to perform investigations to rule out an ACS; the initial ECG was non-ischaemic; and peak symptoms occurred <6 hours previously. Participants were randomised 1:1 to either the LoDED strategy or the usual rule-out strategy. The primary outcome was discharge from the hospital within 4 hours of arrival, without a major adverse cardiac event (MACE) within 30 days. Results Between June 2018 and March 2019, 632 patients were randomised; 3 were later withdrawn. Of 629 patients (age 53.8 (SD 16.1) years, 41% women), 7% had a MACE within 30 days. For the LoDED strategy, 141 of 309 (46%) patients were discharged within 4 hours, without MACE within 30 days, and for usual care, 114 of 311 (37%); pooled adjusted OR 1.58 (95% CI 0.84 to 2.98). No patient with an initial undetectable hs-cTn had a MACE within 30 days. Conclusion The LoDED strategy facilitates safe early discharge in >40% of patients with chest pain. Clinical effectiveness is variable when compared with existing rule-out strategies and influenced by wider system factors. | en_GB |
dc.description.sponsorship | National Institute for Health Research (NIHR) | en_GB |
dc.identifier.citation | Published online 5 May 2020 | en_GB |
dc.identifier.doi | 10.1136/heartjnl-2020-316692 | |
dc.identifier.grantnumber | PB-PG-0416-20012 | en_GB |
dc.identifier.uri | http://hdl.handle.net/10871/121032 | |
dc.language.iso | en | en_GB |
dc.publisher | BMJ Publishing Group / British Cardiovascular Society | en_GB |
dc.rights | © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/. | en_GB |
dc.title | Limit of detection of troponin discharge strategy versus usual care: randomised controlled trial | en_GB |
dc.type | Article | en_GB |
dc.date.available | 2020-05-13T12:13:07Z | |
dc.identifier.issn | 1355-6037 | |
dc.description | This is the final version. Available on open access from BMJ Publishing Group via the DOI in this record | en_GB |
dc.description | Data availability statement: Data are available upon reasonable request. Summary data collected from the study, including de-identified patient level data, can be made available upon request to the corresponding author. | en_GB |
dc.identifier.journal | Heart | en_GB |
dc.rights.uri | https://creativecommons.org/licenses/by-nc/4.0/ | en_GB |
dcterms.dateAccepted | 2020-03-30 | |
rioxxterms.version | VoR | en_GB |
rioxxterms.licenseref.startdate | 2020-03-30 | |
rioxxterms.type | Journal Article/Review | en_GB |
refterms.dateFCD | 2020-05-13T12:11:24Z | |
refterms.versionFCD | VoR | |
refterms.dateFOA | 2020-05-13T12:13:13Z | |
refterms.panel | A | en_GB |
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Except where otherwise noted, this item's licence is described as © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.