Every year, ambulances transport about 200,000 people with chest pain to the First Heart Aid (EHH). During the hospital visit, it turns out that 80 to 90 percent of these people do not have a heart problem and can go home.
Radboudumc cardiologists researchedn the option of initially examining these patients at home, and only forwarding them if there is a high risk of, for example, a heart attack. The research revealed that hospital visits are often unnecessary because there is no heart problem.
Low risk of myocardial infarction
Just under 900 people with chest pain took part in the study in which paramedics assessed their risk of a heart problem. They did this on the basis of the symptoms, age, risk factors, and on the basis of an ECG (heart film). If there was a high risk of a heart attack, a patient was immediately taken to the hospital. If the risk was low, the paramedics analyzed the amount of troponin in the blood. This protein is released when the heart is damaged and is an indication of an imminent heart attack.
Troponin levels
With a high troponin level, a patient immediately went to the hospital. With a low troponin level, the patient stayed at home, provided with further instructions, such as contacting the GP. Subsequently, all patients were followed up to 30 days after the event. This enabled researchers to determine whether a major heart problem, such as a heart attack, still occurred during that period. The chance of this was very small.
In the patient group that stayed at home with a low troponin level, a major heart problem occurred in 0.5 percent of the cases. In the group that still went to hospital with a low troponin level, this was 1.0 percent. “Patients with a low risk of a heart attack can generally stay at home safely. This is good news, because an emergency ambulance ride and hospitalization are major events. Now we know that it is often not necessary,” says physician-researcher Joris Aarts.
Reduce hospital visits
Reducing hospital visits through this new analysis, according to cardiologist and lead researcher Cyril Camaro, results in a significant reduction of costs. “If we introduce this throughout the Netherlands, this will save up to 48 million euros on an annual basis. The Integral Care Agreement emphasizes more efficient care. We all play a role in this,” said Camaro. Researchers had calculated that it saves more than 600 euros per patient if they do not have to go to the hospital.
Camaro also emphasizes better deployment of ambulances: “We deploy ambulance workers in a smarter way. Moreover, despite the home measurement, they are more quickly available for a new patient because they don’t have to go to the EHH with every patient.’ In addition, it also helps to tackle the problem of First Aid closures during busy periods.
Cooperation
In the coming years, Camaro will focus on the implementation of this project. To this end, a national consortium recently came together, comprising all Dutch research groups involved in the assessment of a patient before admission to hospital, the so-called pre-hospital triage. Strict monitoring, proper education and training are crucial for the national roll-out of this new strategy.
After all, it is not yet clear whether this strategy works well in a proportion of patients with chest pain. It is therefore desirable that a national follow-up study is carried out. Camaro considers it important that there will be good cooperation in the chain. “In this research we worked together with many colleagues. It had to be, because a possible change in policy has consequences for everyone: the patient, the ambulance staff, general practitioners, emergency physicians and cardiologists. That’s why we have to do it together.”
Research to reduce hospital visits In January, UMC Utrecht announced that it would be working with 28 other hospitals over the next two years to investigate whether remote guidance is effective for patients with heart failure. More and more hospitals in the Netherlands are guiding patients with chronic complaints in areas such as cardiovascular disease, COPD (lungs) and IBD (gastrointestinal tract) via remote guidance, or home monitoring
