Study shows emergency physicians have good first instincts in diagnosing heart attacks

Jul 24, 2008

A study out of Wake Forest University Baptist Medical Center demonstrates emergency room doctors are correctly identifying patients who are having a heart attack, even when laboratory tests haven't yet confirmed it.

The study used data from a registry called i*trACS, and analyzed patients with heart attack symptoms who were admitted to emergency departments (EDs) in eight participating U.S. centers.

The findings were released today in the Emergency Medicine Journal.

"One of the most common complaints we see in the Emergency Department is chest pain," said Chadwick Miller, M.D., lead author and assistant professor of emergency medicine at Wake Forest Baptist. "That's why it is so important to figure out if we're doing a good job of diagnosing and treating heart attacks, or if there's a better way to do it."

The patients in the registry were divided into three groups: no myocardial infarction (No MI), non-ST segment elevation myocardial infarction (NSTEMI), or evolving myocardial infarction (EMI).

The groups were determined by a blood test that measured levels of the protein troponin, which increases when the heart muscle is damaged from a heart attack.

Patients classified as No MI may have had symptoms but, according to the troponin levels throughout their hospital stay, did not actually have a heart attack. Patients classified as NSTEMI showed elevated troponin levels when first admitted, usually because their heart attack happened several hours or even days before coming to the ED. Patients classified as EMI did not initially show elevated troponin levels when presenting to the ED, but showed evidence of heart damage up to 12 hours later.

The study focused primarily on EMI patients. When a patient was admitted into the ED with heart attack symptoms, doctors at centers participating in the i*trACS registry would record their initial impressions of the symptoms exhibited by the patient. According to the results, the initial impression of the physicians showed that a higher percentage of them assigned a higher risk of heart attack to the EMI (76 percent) and NSTEMI (71 percent) patients, than the No MI (52 percent) group. As a result, the EMI patients were triaged to higher levels of care than the no MI group, despite the initial negative troponin results.

"There has been a lot of concern that clinicians either aren't spending enough time getting clinical history from patients or are not using the information they obtain," said Miller. "Patients with EMI are at particular risk for being evaluated less aggressively because their initial troponin result is normal, even though they have had a heart attack. This study suggests that although we are relying on better medical technology to diagnose patients, the clinical impression is still very important."

"It is reassuring to see that the admission patterns among the EMI patients were more aggressive than with the No MI patients, even though in both groups the patients' troponin results were not elevated. This suggests that clinicians are not allowing the non-elevated troponin results to overshadow their clinical impression."

The i*trACS registry was compiled over a period of 26 months. More than 17,000 patients were enrolled. However, only 4,136 of those patients were included in the analysis, primarily because patients had to have two troponin results within 12 hours to be included. Patients were also excluded from the i*trACS registry if they were pregnant, or under 18 years old.

Source: Wake Forest University Baptist Medical Center

Explore further: Twitter increasingly used to share urological meeting info

add to favorites email to friend print save as pdf

Related Stories

Soccer's key role in helping migrants to adjust

48 minutes ago

New research from the University of Adelaide has for the first time detailed the important role the sport of soccer has played in helping migrants to adjust to their new lives in Australia.

Researchers jailbreak iOS 7.1.2

1 hour ago

Security researchers at the Georgia Tech Information Security Center (GTISC) have discovered a way to jailbreak current generation Apple iOS devices (e.g., iPhones and iPads) running the latest iOS software.

Tracking giant kelp from space

1 hour ago

Citizen scientists worldwide are invited to take part in marine ecology research, and they won't have to get their feet wet to do it. The Floating Forests project, an initiative spearheaded by scientists ...

Recommended for you

Exploring 3-D printing to make organs for transplants

Jul 30, 2014

Printing whole new organs for transplants sounds like something out of a sci-fi movie, but the real-life budding technology could one day make actual kidneys, livers, hearts and other organs for patients ...

High frequency of potential entrapment gaps in hospital beds

Jul 30, 2014

A survey of beds within a large teaching hospital in Ireland has shown than many of them did not comply with dimensional standards put in place to minimise the risk of entrapment. The report, published online in the journal ...

Key element of CPR missing from guidelines

Jul 29, 2014

Removing the head tilt/chin lift component of rescue breaths from the latest cardiopulmonary resuscitation (CPR) guidelines could be a mistake, according to Queen's University professor Anthony Ho.

Burnout impacts transplant surgeons (w/ Video)

Jul 28, 2014

Despite saving thousands of lives yearly, nearly half of organ transplant surgeons report a low sense of personal accomplishment and 40% feel emotionally exhausted, according to a new national study on transplant surgeon ...

User comments : 0