Waiting in an emergency room frustrates patients across the country. Billboards are even popping up on local highways advertising the wait time and a promise for faster care. Chest pain is estimated to cause more than eight million visits annually to overcrowded emergency departments, but a small fraction of patients actually are experiencing heart attacks.
This presents a challenge for physicians who need to determine the next steps for a patient’s care quickly. They don’t want to keep a patient waiting unnecessarily, as it limits the resources available to treat other waiting patients. And they don’t want to risk overlooking a critical diagnosis by discharging a patient too soon. A new blood test is helping physicians address this issue and diagnose patients suffering from heart attacks as quickly as possible.
When a patient experiencing chest pain enters the ER, a physician typically orders a blood test to determine whether the biomarker protein troponin is present. As blood flow to the heart is blocked, the heart muscle begins to die in as few as 30 to 60 minutes and releases this troponin into the bloodstream. The earlier troponin elevations are confirmed, the earlier a physician can initiate care for a patient, potentially minimizing damage to a patient’s heart.
If troponin is not elevated in the first blood draw, sequential blood draws are typically taken to measure troponin levels over the course of a few hours to see if there is an increase. It is during this monitoring period that ERs can become filled with patients. The Siemens Healthineers High-Sensitivity Troponin I test detects smaller changes in a patient’s troponin level as repeat testing occurs, offering physicians greater confidence in the results to enable them to triage patients more quickly.
Confidence in a patient’s test result can determine what steps come next for the patient, steps that could be invasive and costly, explained Jim Freeman of Siemens Healthineers. Physicians need to be able to trust the results before leading a patient down an intensive care pathway, but it’s increasingly challenging with lifestyle and dietary factors that can affect test results if not disclosed by the patient.
“A vitamin supplement that is rising in popularity, called biotin, is known to interfere with some testing biomarkers such as troponin,” Freeman said. “In an emergency situation a patient may not be able to share that they’ve been taking a supplement, so when developing the High Sensitivity Troponin I assay, we took this into account and eliminated the impact of biotin as high as 3500 ng/mL on test results.”
The benefits of the test for hospitals and their patients are significant, Freeman said. “First, the ability to diagnose heart attacks earlier can help to reduce heart death to improve patient outcomes. Second, the ability to exclude heart attacks earlier in a crowded ER can allow for faster care for patients with other emergencies. Third, the increased precision of the Siemens Healthineers High-Sensitivity Troponin I assay enables providers to make more confident decisions, whether admitting the patient or sending the patient home with an antacid.”
The cost of unnecessary admissions and misdiagnosis of heart attacks reaches billions of dollars each year, presenting an opportunity for healthcare providers to improve medical care related to heart attack admissions.
“Our emergency department is overcrowded with patients. If we can do a more efficient job at triaging patients to receive the proper level of care and to discharge the patients who do not need to stay in the emergency department, this will have a tremendous economic advantage for our healthcare system,” said Dr. Alan Wu of Zuckerberg San Francisco General Hospital and Trauma Center.