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https://hdl.handle.net/2440/111070
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Type: | Journal article |
Title: | A randomized trial of a 1-hour troponin T protocol in suspected acute coronary syndromes: design of the rapid assessment of possible ACS in the emergency department with high sensitivity troponin T (RAPID-TnT) study |
Author: | Papendick, C. Blyth, A. Seshadri, A. Edmonds, M. Briffa, T. Cullen, L. Quinn, S. Karnon, J. Chuang, A. Nelson, A. Horsfall, M. Morton, E. Chew, D. |
Citation: | American Heart Journal, 2017; 190:25-33 |
Publisher: | Elsevier |
Issue Date: | 2017 |
ISSN: | 0002-8703 1097-6744 |
Statement of Responsibility: | Cynthia Papendick, Andrew Blyth, Anil Seshadri, Michael J. R. Edmonds, Tom Briffa, Louise Cullen, Stephen Quinn, Jon Karnon, Anthony Chuang, Adam J. Nelson, Matthew Horsfall, Erin Morton and Derek P. Chew |
Abstract: | Background: Protocols incorporating high-sensitivity troponin to guide decision making in the disposition of patients with suspected acute coronary syndromes (ACS) in the emergency department have received a lot of attention. Traditionally, patients with chest pain have required long periods of observation in emergency department before being deemed safe for discharge. In an era of limited health service resources, a protocol that could discharge patients safely within an hour of presentation is extremely attractive. Unfortunately, despite incorporation into some guidelines, these protocols have not been subjected to randomized comparisons evaluating safety, effectiveness, and cost-effectiveness. Objective: This study is designed to provide the evidence required to allow key decision makers to implement these protocols: specifically, to provide evidence that a decision rule based on 0- and 1-hour high-sensitivity troponin T (hs-TnT) is safe, provides noninferior outcomes in all patients with suspected ACS, and that implementation of a rapid troponin protocol leads to efficient care. Design: This prospective pragmatic trial (n = 5,400, 5 hospitals) randomly allocates patients with suspected ACS to either a 0/1-hour hs-TnT protocol as advocated in clinical guidelines, versus usual care of standard troponin reporting evaluated at 3 and 6 hours. The primary effectiveness composite end points of this study are all-cause death and new/recurrent ACS within 30 days. To evaluate cost-effectiveness, follow-up will determine clinical events, quality of life, and resource utilization within 12 months. Summary: Demonstrating that a 0/1-hour hs-TnT protocol improves the effectiveness and efficiency of care within a robust comparative study will fill an evidence gap that currently limits the translation of more precise hs-TnT testing into better patient and health service outcomes. |
Keywords: | Humans Disease Progression Troponin T Electrocardiography Incidence Cause of Death Survival Rate Risk Assessment Follow-Up Studies Prospective Studies Time Factors Quality of Life Middle Aged Emergency Service, Hospital Australia Female Male Acute Coronary Syndrome |
Rights: | Crown Copyright © 2017 Published by Elsevier Inc. All rights reserved. |
DOI: | 10.1016/j.ahj.2017.05.004 |
Grant ID: | http://purl.org/au-research/grants/nhmrc/1124471 |
Published version: | http://dx.doi.org/10.1016/j.ahj.2017.05.004 |
Appears in Collections: | Aurora harvest 8 Medicine publications |
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