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Trial of assessing chest pain underway in rural Waikato

Pinnacle Midlands Health Network (Pinnacle MHN) will use a $15,000 grant from the Heart Foundation to help fund the trial of a new method for assessing chest pain among people in rural Waikato.

Pinnacle MHN has developed a rural chest pain method, referred to as a pathway, that will allow low-risk patients in rural communities to be safely assessed by their general practice, rather than travelling significant distances to hospital.

The trial of the pathway will kick-off at the end of October, and will include the introduction of a chest pain assessment tool and point of care machine into 12 rural GP practices across the Waikato region.

Pinnacle MHN project manager Tim Norman explains the trial in more detail.

"Currently, when a patient presents at their GP clinic with chest pain, there are a number of tests the doctor undertakes to confirm whether a patient is at risk of experiencing a major cardiac event, including taking a blood sample.

"Depending on where the clinic is located, this may mean a lengthy delay (up to 2 or 3 hours in some areas) whilst the sample is transported to the nearest laboratory, and then analysed. We aim to speed-up the process.

"The chest pain assessment tool we are trialing in rural GP practices is similar to Emergency Department Assessment Chestpain (EDAC), a tool developed by director of Emergency Medicine research at Christchurch Hospital, Dr Martin Than, and currently in widespread use in hospital emergency departments throughout New Zealand.

"EDAC has been successfully used in emergency departments for some time so we decided to adapt it for use in primary care. We have specifically adapted it to suit a rural primary care setting. Under the pathway we have developed, GPs are able to identify if a patient is at low or high risk of a major cardiac event via a series of questions.

"Those who are identified as high risk are sent directly to hospital. Those who are identified as low risk are then further assessed by a point of care machine known as an i-STAT handheld blood analyser supplied by Abbott Point of Care, who are also supporting the trial.

"Blood is routinely taken during a suspected heart event to check for cardiac enzymes and the presence of the protein troponin, which indicates possible cardiac muscle damage. With this new pathway, once the GP takes the patient's blood it is immediately tested in the i-STAT to confirm that the patient is at low risk of a cardiac event. As an additional cross check during the trial, a second sample is also sent to the local laboratory."

"The simple test using the i-STAT will take a maximum of 20 minutes to administer and diagnose. The GP then combines this information with the results of the EDAC assessment and other routine tests such as echo cardiogram giving them a complete picture of what is going on," explains Tim.

Tim said the tool is relevant in rural GP practices because up to 70% of people who present with chest pain at Emergency Departments are discharged and require little or no medical follow up.

"We know that around 3,500-4,000 people present to ED with chest pain in the Waikato alone every year. We are confident that this new chest pain pathway has the ability to significantly reduce those numbers, benefiting individuals and the overall health system.

"It's important to stress that the safety and care of the patient is paramount at all times, and that the rural chest pathway being trialled does not replace good clinical judgement for GPs, it's an alternative way of identifying who is low and high risk of a heart episode," Tim said.

Tim said the potential benefits of the new rural chest pain pathway for rural patients include: being able to stay closer to home, and a reduction in unnecessary ambulance transfers, ED presentation and hospital admissions. The pathways may be particularly beneficial for those who are frail and or elderly.

The project is on track to kick off at the end of October, with three GP clinics a week due to come online with the trial each week during November. The project will run for around 12 months and will collect data from 500+ patients.

"We're grateful to our sponsors, including the Heart Foundation, for bringing this trial to fruition."

Pinnacle MHN CEO John Macaskill-Smith said Pinnacle MHN serves one of the largest rural populations in New Zealand. "It's our focus to provide rural general practice with the tools and pathways that enable patients to be treated by the right person, at the right place, at the lowest cost to the health system. This pathway will contribute to that goal," he said.



Caption: Pinnacle MHN project manager Tim Norman launches the chest pain pathway to the 12 rural GP practices participating in the trial.


Caption: Abbott Point of Care demonstrate the point of care machine, known as an i-STAT handheld blood analyser, to GPs at the chest pain pathway launch.

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