4 January 2019

Many patients who suffer from chest pain are not actually having a heart attack, making an emergency hospital visit unnecessary. For such cases, intervention cardiologist Cyril Camaro of Radboud university medical center is investigating if there is a way to quickly and accurately determine at home whether emergency hospital treatment is necessary or a visit to the general practitioner is sufficient. Calculations suggest that this method could potentially save tens of millions of euros on healthcare costs.

Chest pain is an indication of a heart attack. The standard reaction is to call an ambulance immediately and rush to the cardiac emergency facility or the general emergency room of the hospital. “Various studies indicate that a hospital visit is unnecessary for approximately one in three patients with chest pain,” says Cyril Camaro, intervention cardiologist of Radboud university medical center. “More than thirty per cent of such patients have such a low risk of heart attack that there is probably something else going on.”
 
Effective care
How can it be determined who should go to a hospital for emergency treatment and who should go to the general practitioner for an examination? That question is the basis of the ARTICA study that Camaro will perform in the Nijmegen region in early 2019. The study is funded by an efficacy grant from ZonMw of nearly half a million euros.
“Patients with chest pain should still call for medical help immediately,” says Camaro, “that does not change. Some of these patients will be immediately taken to the hospital by ambulance as usual. These patients will be the control group so we can determine the efficacy of the new approach.”
 
HEART score
The patients in the other group will be assessed by the ambulance staff on the basis of a questionnaire, which can be summarized with the acronym HEART. The History of the patient is examined, an ECG is made, the patient’s Age is taken into account and a Risk score is determined with factors such as obesity, diabetes and other disorders. If this HEART score is very low, the likelihood of a heart attack is also low. Additionally, the substance troponin (T) is measured in the blood to exclude the possibility of a heart attack. Troponin is a small protein that can be found in high concentrations in the blood in case of heart damage, which happens during a heart attack.
 
Major cost reduction
If the HEART score is low, the patient can go to the general practitioner for additional examination and testing to determine what is causing the chest pain. Camaro: “Sometimes this pain is caused by stomach or muscle complaints, by stress or because someone has a respiratory infection or pneumonia. Chest pain can have many causes. If we can exclude a heart attack in many patients by using the HEART score, they will not have to go to the hospital for an emergency examination. This gives many patients clarity at an earlier stage, uses ambulances more efficiently, and keeps the scarce beds in the cardiac and general emergency wards available for patients with life-threatening problems. According to our calculations, this can result in substantial savings in healthcare costs. If this ARTICA study demonstrates that this approach works, it can save up to forty million euros per year when implemented nationally.”
 

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