Pre-hospital diagnosis of minor heart attacks

Dr Luke Dawson, Monash University

2020 Health Professional Scholarship

Years funded: 2021-2023

Heart attacks remain a leading cause of morbidity and mortality in developed countries including Australia. Early diagnosis and initiation of treatment is known to have a significant impact on prognosis. Non-traumatic chest pain symptoms are the leading cause of ambulance services use in Victoria and represent approximately 15% of the emergency caseload for Ambulance Victoria. Currently, there is no protocol for paramedics to determine which patients are high risk and suffering a minor heart attack in whom early treatment (with cardiac catheterization and stenting) may be indicated, and which patients are lower risk and are likely to have a diagnosis of stable coronary disease or non-cardiac chest pain. All chest pain patients are therefore currently transferred by ambulance to their nearest hospital emergency department regardless of whether the hospital has a stenting service. This leads to a significant financial and resource burden with more than 3000 annual secondary ambulance transfers for patients who require cardiac catheterization facilities.

The aim of this project is to assess the feasibility of integrating a risk assessment tool, including the use of point-of-care high-sensitivity troponin-I testing (a blood test used in hospitals to detect heart attacks), to accurately risk stratify chest pain patients in the pre-hospital setting. Using this tool, paramedics can determine the need for high-risk patients to proceed directly to a stent capable centre (reducing the financial and resource burden of ambulance inter-hospital transfers), while for lower risk patients, ambulance based risk assessment may allow patients to be directed to more appropriate primary care providers. Further, a positive point-of-care troponin test in the ambulance could potentially allow early diagnosis of minor heart attacks and facilitate earlier access to definitive treatment at the hospital. The study aims to enroll 1,800 patients with non-traumatic chest pain over 3 years.