New test set to improve care for patients with suspected heart attack

May 2, 2014 by Emma Smith, University of Manchester

Manchester researchers have developed a novel approach, called the Manchester Acute Coronary Syndromes Decision Rule, to more quickly and effectively diagnose heart attack in patients admitted to emergency departments.

Chest pain is the most common reason for emergency hospital admission. In Manchester, the incidence of premature death due to heart disease and stroke is amongst the highest in England. The rule has the potential to safely reduce unnecessary hospital admissions, and more appropriately allocate time and resource to who need help most.

The study published today in the international, peer-reviewed medical journal, Heart, indicates that using the simple decision rule will help doctors to make more accurate decisions based on a patient's symptoms and the results of simple blood tests. This could reduce the need for patients to be unnecessarily admitted to hospital for further tests, and rapidly identify the highest risk patients, so that they can receive appropriate treatments more quickly.

The researchers from Manchester Royal Infirmary, Stockport NHS Foundation Trust, The University of Manchester, and Manchester Metropolitan University, discovered that the decision rule could allow more than one in four patients with to be safely and immediately discharged from the . In contrast, the decision rule also accurately classifies around one in ten patients with chest pain as 'high risk', enabling them to receive more intensive treatment at an early stage and to be treated in a specialist area such as a coronary care unit.

Clinicians have been using the results of blood tests to detect heart attacks for some time. The most widely used test, which detects a protein called troponin, can identify nine out of ten heart attacks when patients first arrive in the emergency department. However, it can take several hours for troponin levels to rise in the blood after a , which means that many patients are admitted to hospital to wait for later tests. Most of these later tests show normal results, so the availability of an accurate test that can be undertaken earlier in the process has the potential to avoid many unnecessary hospital admissions.

The decision rule combines the results of the first troponin test with levels of another protein that may detect earlier signs of heart damage: heart-type fatty acid binding protein. It also takes into account a patient's symptoms and the findings from the electrocardiogram (ECG), which shows the flow of electricity through the heart. Using a simple computer program, doctors can determine from the decision rule the chance that a patient is having a heart attack. This research found that none of the patients who were identified by the decision rule as being safe to discharge from the emergency department had a heart attack. In contrast, over 95 per cent of the patients in the 'high risk' category had a heart problem.

Dr Rick Body, Consultant in Emergency Medicine at Manchester Royal Infirmary and Honorary Lecturer in Cardiovascular Medicine at The University of Manchester, who led the study said, "This study could potentially make a huge difference to the way we diagnose attacks and the subsequent treatment options for our patients.

We have now tested the accuracy of the rule in more than 1100 patients by observing what could have happened if we'd have used the decision rule instead of providing our routine care. This study provides the safety and effectiveness evidence required for us to start using the decision rule to guide patient care. In the next phase of our work we will carefully study the potential benefits of the decision rule for both patients and the NHS".

Explore further: Blood test helps predict heart attack risk for patients with chest pain

More information: "The Manchester Acute Coronary Syndromes (MACS) decision rule for suspected cardiac chest pain: derivation and external validation." Richard Body, Simon Carley, Garry McDowell, Philip Pemberton, Gillian Burrows, Gary Cook, Philip S Lewis, Alexander Smith, Kevin Mackway-Jones. Heart heartjnl-2014-305564Published Online First: 29 April 2014 DOI: 10.1136/heartjnl-2014-305564

Related Stories

Blood test helps predict heart attack risk for patients with chest pain

March 31, 2014
Patients presenting to the emergency department with an undetectable level of the blood biomarker high-sensitivity cardiac troponin T, and whose ECGs show no sign of restricted blood flow, have a minimal risk of heart attack ...

Test accurately rules out heart attacks in the ER (Update)

March 30, 2014
A simple test appears very good at ruling out heart attacks in people who go to emergency rooms with chest pain, a big public health issue and a huge worry for patients.

Manchester patients take part in pioneering heart attack blood test trial

February 27, 2013
High levels of a chemical called troponin in the blood can indicate a heart attack. A new, highly sensitive blood test for troponin will be used on blood samples donated by 140 patients who were admitted to MRI with chest ...

New blood test could detect heart attacks more quickly

February 25, 2014
A new blood test can detect heart attacks hours faster than the current gold-standard blood test, according to a study led by Loyola University Chicago Stritch School of Medicine researchers.

Simple test in the ambulance saves lives after heart attack, new study finds

April 14, 2014
A new study from the University of Surrey, published today in the journal Heart, has identified a positive link between the survival of heart attack patients and the use of an electrocardiogram (ECG), by ambulance crews.

New method quickly determines if chest pain is acute coronary syndrome

November 5, 2013
Researchers at Karolinska Institutet have tested a new method for quickly ruling out acute myocardial infarction or other serious acute coronary disease in emergency department patients complaining of chest pains. The method, ...

Recommended for you

A nanoparticle inhalant for treating heart disease

January 18, 2018
A team of researchers from Italy and Germany has developed a nanoparticle inhalant for treating people suffering from heart disease. In their paper published in the journal Science Translational Medicine, the group describes ...

Starting periods before age of 12 linked to heightened risk of heart disease and stroke

January 15, 2018
Starting periods early—before the age of 12—is linked to a heightened risk of heart disease and stroke in later life, suggests an analysis of data from the UK Biobank study, published online in the journal Heart.

'Decorated' stem cells could offer targeted heart repair

January 10, 2018
Although cardiac stem cell therapy is a promising treatment for heart attack patients, directing the cells to the site of an injury - and getting them to stay there - remains challenging. In a new pilot study using an animal ...

Two simple tests could help to pinpoint cause of stroke

January 10, 2018
Detecting the cause of the deadliest form of stroke could be improved by a simple blood test added alongside a routine brain scan, research suggests.

Exercise is good for the heart, high blood pressure is bad—researchers find out why

January 10, 2018
When the heart is put under stress during exercise, it is considered healthy. Yet stress due to high blood pressure is bad for the heart. Why? And is this always the case? Researchers of the German Centre for Cardiovascular ...

Heart-muscle patches made with human cells improve heart attack recovery

January 10, 2018
Large, human cardiac-muscle patches created in the lab have been tested, for the first time, on large animals in a heart attack model. This clinically relevant approach showed that the patches significantly improved recovery ...


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.