Rory Miller1, Tim Stokes2, Garry Nixon3. 1. Senior Lecturer: Rural Post-Graduate Programme, Dean's Department, Dunedin School of Medicine, University of Otago, Dunedin; Rural Doctor, Thames Hospital, Waikato District Health Board, Waikato. 2. Elaine Gurr Professor of General Practice and Head of Department, Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin. 3. Head of Rural Section and Associate Dean Rural: Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin; Rural Doctor, Dunstan, Central Otago Health Services.
Abstract
AIMS: Accelerated diagnostic chest pain pathways (ADP) have become standard of care in urban emergency departments. It is, however, unknown how widely they are used in New Zealand's rural hospitals because ADP require immediate access to contemporary or high-sensitivity troponin (hs-Tn). We aimed to determine for rural hospitals the troponin assay being used, if they were using an ADP and if they had access to on-site exercise tolerance testing (ETT). METHODS: An online survey was sent to 27 rural hospitals providing acute care in New Zealand. RESULTS: Most rural hospitals (23/27, 85%) responded to the survey. Most (17/23, 74%) used point-of-care cardiac troponin (POC-cTn) and the majority of these hospitals (15/17, 88%) were reliant on this assay 24-hours per day. All hospitals that had timely access to hs-Tn (8/23, 35%) used an ADP but only a minority (4/17, 24%) of hospitals using POC-cTn used an ADP. Only a minority of the larger rural hospitals (7/23, 30%) had access to on-site ETT. CONCLUSIONS: Most New Zealand rural hospitals rely on POC-cTn to assess chest pain and are not using an ADP. There are limited data available to support this approach in rural settings especially with patients who are not low-risk.
AIMS: Accelerated diagnostic chest pain pathways (ADP) have become standard of care in urban emergency departments. It is, however, unknown how widely they are used in New Zealand's rural hospitals because ADP require immediate access to contemporary or high-sensitivity troponin (hs-Tn). We aimed to determine for rural hospitals the troponin assay being used, if they were using an ADP and if they had access to on-site exercise tolerance testing (ETT). METHODS: An online survey was sent to 27 rural hospitals providing acute care in New Zealand. RESULTS: Most rural hospitals (23/27, 85%) responded to the survey. Most (17/23, 74%) used point-of-care cardiac troponin (POC-cTn) and the majority of these hospitals (15/17, 88%) were reliant on this assay 24-hours per day. All hospitals that had timely access to hs-Tn (8/23, 35%) used an ADP but only a minority (4/17, 24%) of hospitals using POC-cTn used an ADP. Only a minority of the larger rural hospitals (7/23, 30%) had access to on-site ETT. CONCLUSIONS: Most New Zealand rural hospitals rely on POC-cTn to assess chest pain and are not using an ADP. There are limited data available to support this approach in rural settings especially with patients who are not low-risk.
Authors: Rory Miller; Garry Nixon; John W Pickering; Tim Stokes; Robin M Turner; Joanna Young; Marc Gutenstein; Michelle Smith; Tim Norman; Antony Watson; Peter George; Gerald Devlin; Stephen Du Toit; Martin Than Journal: Eur Heart J Acute Cardiovasc Care Date: 2022-06-14