None listed
Conditions
Brief summary
Chest pain is one of the most common reasons adults present to the emergency department and efficient diagnosis of life threatening conditions such as heart attack is of primary concern to patients and physicians alike. Accelerated diagnostic protocols assist doctors to efficiently exclude cardiac causes of chest pain, decreasing the time patients wait for diagnosis. The ImpACT (Improved Assessment of Chest pain Trial) Protocol is an evidenced based accelerated diagnostic protocol which fasttracks chest pain assessments in 75% of patients. Currently standard practice in a major Brisbane metropolitan hospital, the protocol is undergoing implementation at Cairns Hospital as a quality assurance exercise (HREC/16/QRBW/262). Aboriginal and/or Torres Strait Islander patients were underrepresented in the original ImpACT Study. A landmark 2006 report by the Australian Institute of Health and Welfare identified that Aboriginal and Torres Strait Islander people are three times more likely to have a major coronary event (such as a heart attack) compared with other Australians. The higher burden of disease in this cohort of patients may lead to emergency physicians to consider these patients at higher baseline risk of Acute Coronary Syndrome when presenting with possible cardiac chest pain. However, to date there is no robust clinical research to support this assumption. The study aims to identify if Aboriginal and/or Torres Strait Islander status is an independent risk factor for acute coronary syndrome (ACS) in patients otherwise identified as low risk by the ImpACT protocol. The health service costs for Aboriginal and Torres Strait Islander patients with suspected coronary syndromes will be evaluated. Researchers hope to provide preliminary data contributing to the development of a safe, efficient, evidenced based pathway of care for Aboriginal and Torres Strait Islander patients presenting to Emergency Departments with suspected Acute Coronary Syndrome. All patients who identify at triage to be of Aboriginal or Torres Strait Islander origin will be assessed and managed under a modified Impact protocol risk stratified as either Intermediate or High risk; but not low risk of Acute Coronary Syndrome. Treatment and management of patients will remain unchanged regardless of participation in the study. Conservatively over 8 months the researchers anticipate recruiting 160 Aboriginal and Torres Strait Islander patients. Initial patient clinical data collation and follow up patient contact will be conducted by a dedicated clinical research officer. Retrospective analysis of patient outcomes and health services costs will be evaluated.
Interventions
1. Patients who present to Cairns Emergency department with chest pain or symptoms of suspected ACS and who identify as Aboriginal or Torres Strait Islander who are clinically appropriate will be assessed as per the ImpACT pathway. The ImpACT pathway is an accelerated diagnostic protocol which has been implemented at the Cairns Hospital. Patients are risk stratified as either high, intermediate or low risk of suspected ACS and managed according to the protocol.
High Risk patients meet one or m
1. Patients who present to Cairns Emergency department with chest pain or symptoms of suspected ACS and who identify as Aboriginal or Torres Strait Islander who are clinically appropriate will be assessed as per the ImpACT pathway. The ImpACT pathway is an accelerated diagnostic protocol which has been implemented at the Cairns Hospital. Patients are risk stratified as either high, intermediate or low risk of suspected ACS and managed according to the protocol. High Risk patients meet one or more of the following criteria: Elevated troponin (TnI); Ischaemic ECG changes; Left ventricular ejection fraction <40%; New Mitral Valve Regurgitation; Haemodynamic compromise; Syncope; Percutaneous Coronary Intervention within 6 months; Coronary Artery Bypass Grafting; Diabetes Mellitus with typical symptoms; Estimated Glomerular Filtration Rate ,60ml/min with typical symptoms and >or=40 years of age. High Risk patients are admitted under the care of Cardiology and receive repeat troponin testing 6 hours after presentation. Intermediate Risk patients have no high risk features but one or more of the following criteria present: >or= 40 years of age; No Ischaemic ECG changes; First Troponin TnI Low Risk patients have no intermediate or high risk features and are less than 40 years of age. These patients are cared for in the Emergency Department and receive a repeat TnI and ECG after 2 hours. If these tests are normal, patients are discharged and referred back to their General Practitioner for modification of cardiac risk factors. Patients who are over 18 years of age or older, who identify as Aboriginal or Torres Strait Islander are NOT managed as low risk according to the ImpACT protocol. These patients are managed as either Intermediate Risk or High Risk of suspected ACS according to their other risk factors. This is the standard care that patients are currently receiving at Carins Hospital. The research study is observational only and the care of patients does not change irrespective of their participation in the research. Patients will be invited to provide free and informed consent. The research nurse will record baseline data, the results of initial assessment (including biomarker results), data required for risk stratification and admission/discharge from the ED. 2. Research staff will contact ALL patients enrolled in the study by telephone at 30 days to identify subsequent attendances/admissions and adverse events up to 30 days after initial presentation. 3. Follow-up will occur at 30 days post initial presentation 4. Participants recruited from 2019 had a highly sensitive troponin assay collected due to a change in the assay across Pathology Queensland laboratories. 5. Newly recruited participants have also consented to follow up at 12 months following presentation.
Sponsors
Queensland University of Technology
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Patients will be included if they are aged 18 years and above, identify as Aboriginal and/or Torres Strait Islander, have presented to the Cairns Hospital Emergency Department and: 2. Present with symptoms of 5 minutes or more in duration consistent with possible ACS such as chest discomfort or angina equivalent; AND/OR; Physicians plan to evaluate the patient for suspected ACS
Exclusion criteria
Patients will be excluded from the research study if: 1. They are pregnant 2. Aged less than 18 years old 3. A clear alternative non-ACS diagnostic cause for symptoms is determined 4. The researcher feels that recruitment is inappropriate (e.g. Terminal illness) 5. The patient (or legal representative) is unable or unwilling to provide informed consent 6. Patient (or legal representative) refusal of telephone follow up or medical record review at 30 days or unlikely to be contactable e.g. they will be overseas 7. The patient has been transferred from another hospital with sensitive troponin testing commenced at referring facility 8. The patient has been recruited to the trial within the last 30 days.
Outcome results
None listed