LoDED study findings

Introduction

When someone arrives in the accident and emergency (A&E) department with chest pain, it is hard for doctors to tell whether the pain is due to a heart attack. Some patients have to wait in hospital and have two blood tests taken hours apart before a heart attack can be ruled out. Only 1 in 10 of these patients have had a heart attack – most have less serious conditions like heartburn. Ruling out heart attacks faster would reassure patients earlier and reduce their time spent in hospital. A blood test called high-sensitivity troponin may be used to rule out heart attacks using just one blood sample shortly after a patient arrives in the A&E department. This test measures low levels of heart muscle damage in the blood. This study aimed to find out whether this test works in everyday practice.

Methods

We asked over 600 patients with chest pain, arriving at eight A&E departments in England and Wales, to take part. We allocated them by chance to one of two groups. One group was discharged after one blood test if no heart damage was found. The other group had one or two blood tests as usual depending on local practice. We compared groups to see how many patients could be discharged within four hours. Patient volunteers helped us to design the research and ensure that the study was acceptable to patients.

Results and discussion

Using the new single test, over 40% of patients were discharged early and safely. The new test worked better in some hospitals than others, which may have been due to how busy the A&E department was. The research was successful and helpful to both patients and doctors. The study's results are freely available to doctors and patients to allow improvements in care. The Chief Investigator will work with the NHS to bring this new test into everyday practice.