Recommendations that will lead to the quicker identification and improved care of patients with serious heart disease in Scottish hospitals are made today.
(Launch: 10.00am, Monday 15 December, the Boardroom, Floor 6, Delta House, 50 West Nile Street, Glasgow)
Recommendations that will lead to the quicker identification and improved care of patients with serious heart disease in Scottish hospitals are made today (Monday 15 December) by NHS Quality Improvement Scotland (NHS QIS).
NHS QIS will issue advice to NHSScotland recommending that a simple blood test, called troponin testing, should be available in all hospitals in Scotland that see patients with chest pain.
This blood test, when used in conjunction with other signs and symptoms, can help establish if someone with chest pain has an acute coronary syndrome (ACS).
Troponin tests alone cannot make a diagnosis, and doctors will also need to consider the results of an electrocardiogram (ECG) reading, physical symptoms, and the patient’s medical history.
Together with other information, a positive troponin result can help decide whether a patient with chest pain has suffered serious heart damage and requires treatment in hospital. A negative result can help decide if someone is at low immediate risk of heart damage and can go home earlier safely.
The test takes its name from proteins, called troponins, that are released into the blood when muscle cells in the heart are damaged.
A blood test will show how much troponin is in the blood and provides a quick and accurate measure of heart muscle damage.
Troponin testing is currently available in most Scottish hospitals. However, where it is available, it is used in different ways.
NHS QIS has recommended that patients with a suspected ACS should be tested 12 hours after symptoms begin. If the onset of symptoms is difficult to establish then the test should be taken 12 hours after admission. This ensures that troponin is measured within the period when it is at its highest.
In patients who have clearly had a heart attack, treatment should begin immediately and there is no need to wait for a troponin test prior to starting treatment. However in such patients, a troponin test at 12 hours after admission can identify mis-diagnosis and provide useful information to doctors.
Troponin may be measured on admission in patients with suspected ACS, with a second test taken later if the first test is negative. This recommendation only applies to hospitals that can adapt their services to treat patients on the basis of these two results.
Decisions on which service to adopt should be determined according to local need. In some hospitals the blood sample will be sent to a laboratory to get the result, in others this can be done on the ward or department close to where the patient is being assessed (known as point-of-care testing).
NHS QIS Interim Director, Health Technology Assessment, Dr Harpreet Kohli said: Currently, access to troponin testing varies throughout Scotland. Implementing our advice is a first step to establishing consistent care across Scotland for patients who are admitted to hospital with chest pain.
It means that more patients with serious heart damage are identified earlier and will get the right treatment sooner, while patients at low risk can be safely sent home earlier. These measures will also enable resources to be devoted to those in most clinical need.
ENDS
NOTES TO EDITORS
NHS Quality Improvement Scotland will launch the Advice on troponin testing in acute coronary syndromes at 10am today <15 December 2003 />. Media representatives are welcome to attend the launch at: the Boardroom, 6th floor, Delta House, 50 West Nile Street, Glasgow. The full report will be available from 10.00am today on the NHS QIS website:
Coronary heart disease, acute coronary syndromes
1. Coronary heart disease (CHD) describes a range of diseases affecting the cardiovascular system (including acute coronary syndromes).
2. Scotland has one of the highest CHD-related mortality rates in Western Europe. In 2002, 11 700 deaths related to CHD were recorded.
3. Acute coronary syndromes are conditions associated with possible or actual heart damage caused by impaired blood supply. They include heart attacks and unstable angina. Last year about 21,000 patients were admitted to hospitals in Scotland with unstable angina or MI.
4. About 20-30% of all emergency medical admissions in the UK involve patients with chest pain, but less than one third of those will be kept in hospital because of an acute coronary syndrome.
5. An electrocardiogram provides a recording of the electrical activity of the heart.
Health Technology Assessment
NHS QIS used an internationally recognised process called Health Technology Assessment to form its advice. This took account of the evidence on the medical, social, ethical, and economic implications of using troponin testing in acute coronary syndromes. A group of experts, chaired by Dr Iain Findlay, cardiologist at Royal Alexandra Hospital, Paisley, advised NHS QIS.
NHS QIS Remit:
NHS Quality Improvement Scotland (NHS QIS) has been established to improve the quality of healthcare in Scotland. To do this, it will set standards and monitor performance, and provide NHSScotland with advice, guidance and support on effective clinical practice and service improvements.
This NHS QIS system of assuring quality is designed to complement the duty that has been laid upon the board of each NHS body by the Health Act 1999 to monitor and improve the quality of healthcare which it provides to individuals (clinical governance).
NHS QIS is independent from government. Although it is accountable to the Scottish Executive for delivering its work programme and for the public money it spends, NHS QIS reaches its own conclusions on the quality of services being provided by the NHS, and publishes its findings.
Background:
Established on 1 January 2003, NHS Quality Improvement Scotland is a Special Health Board, built on the expertise developed within the:
Clinical Resource and Audit Group
Clinical Standards Board for Scotland
Health Technology Board for Scotland
Nursing and Midwifery Practice Development Unit
the Scottish Health Advisory Service.
Chaired by Lord Patel, the Board has a broad membership that includes NHS staff and members of the public. Dr David Steel is Chief Executive.
NHS QIS Interim Director, Health Technology Assessment Dr Harpreet Kohli and consultant cardiologist Dr Iain Findlay are available for interview after the news conference.
Contacts:
Rob MacPhail, Communications Officer, NHS Quality Improvement Scotland, tel: (dl) or 07855 838 340 (mob)
ENDS