Troponin testing in primary care: can it improve diagnosis and prevent admission?
Abstract
Introduction:
With the growing demand on emergency departments, expanses in the clinical capabilities of prehospital healthcare facilities have become a hot topic. The use of point-of-care troponin testing (POCTT) has been greatly debated due to the sensitivity limitations of the current testing machines. The current systematic review will collate the current research and attempt to confirm whether troponin testing in primary care can improve diagnostic capabilities and prevent onward admission where appropriate.
Methods:
The literature search was carried out using PubMed and Embase databases with MeSH terms derived from the US National Library of Medicine. Key data points were extracted pertaining to areas such as cost, unnecessary admission, incorrect diagnosis and mortality, with a descriptive analysis completed.
Results:
Cost – An overall improvement in cost of patient care was noted. Unnecessary admission – A reduction in unnecessary admission was reported. Acute coronary syndrome (ACS) exclusion – Improved ACS exclusion was assumed due to improved admission rates. Mortality – No POCTT-associated mortality was reported. Incorrect diagnosis – Misdiagnosis rates between 1.02–5.2% with some associated morbidity.
Conclusion:
POCTT could be safely used when combined with current risk-stratification tools and delayed testing to mitigate the limitations with low-sensitivity testing.
Cardiovascular disease (CVD) is one of the leading causes of death worldwide. Approximately 17.9 million people die each year as a result of CVD, accounting for 31% of the world's reported deaths (World Health Organization (WHO), 2021). This number may be higher as more than 75% of these deaths are reported in low–middle income countries where the recording of deaths is historically less reliable.
The majority of CVD presentations are as a result of acute coronary syndrome (ACS), which encompasses a plethora of cardiac conditions including angina and myocardial infarction (MI) (Joint Formulary Committee (JFC), 2022). The clinical manifestation of these conditions in the acute setting usually has chest pain as the dominant symptom. Chest pain is a common presentation for patients in the primary care setting with 1.5% of all consultations relating to this complaint (Harskamp et al, 2019).
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