Table of Contents
International Journal of Family Medicine
Volume 2013, Article ID 532093, 7 pages
http://dx.doi.org/10.1155/2013/532093
Research Article

Point-of-Care Troponin T Testing in the Management of Patients with Chest Pain in the Swedish Primary Care

1Primary Care, Department of Medical and Health Sciences, Faculty of Health Sciences, Linköping University, East County Primary Health Care, County Council of Östergötland, 581 83 Linköping, Sweden
2Central County Primary Health Care, County Council of Östergötland, 581 85 Linköping, Sweden
3Primary Care, Department of Medical and Health Sciences, Faculty of Health Sciences, Linköping University, 581 83 Linköping, Sweden
4Division of Biomedical Laboratory Science, Department of Medical and Health Sciences, Faculty of Health Sciences, Linköping University, Department of R&D Unit in Local Health Care, County Council of Östergötland, 581 85 Linköping, Sweden
5Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Faculty of Health Sciences, Linköping University, 581 85 Linköping, Sweden
6Department of Cardiology UHL, County Council of Östergötland, 581 85 Linköping, Sweden
7East County Primary Health Care, County Council of Östergötland, 601 82 Norrköping, Sweden
8Division of Clinical Chemistry, Department of Clinical and Experimental Medicine, Linköping University, County Council of Östergötland, 581 83 Linköping, Sweden
9Division of Cardiology, Department of Internal Medicine, County Hospital Ryhov, 551 85 Jönköping, Sweden

Received 6 October 2012; Accepted 10 December 2012

Academic Editor: Jean W. M. Muris

Copyright © 2013 Staffan Nilsson et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective. To investigate the diagnostic accuracy and clinical benefit of point-of-care Troponin T testing (POCT-TnT) in the management of patients with chest pain. Design. Observational, prospective, cross-sectional study with followup. Setting. Three primary health care (PHC) centres using POCT-TnT and four PHC centres not using POCT-TnT in the southeast of Sweden. Patients. All patients ≥35 years old, contacting one of the primary health care centres for chest pain, dyspnoea on exertion, unexplained weakness, and/or fatigue with no other probable cause than cardiac, were included. Symptoms should have commenced or worsened during the last seven days. Main Outcome Measures. Emergency referrals, patients with acute myocardial infarctions (AMI), or unstable angina (UA) within 30 days of study enrolment. Results. 25% of the patients from PHC centres with POCT-TnT and 43% from PHC centres without POCT-TnT were emergently referred by the GP ( ). Seven patients (5.5%) from PHC centres with POCT-TnT and six (8.8%) from PHC centres without POCT-TnT were diagnosed as AMI or UA ( ). Two patients with AMI or UA from PHC centres with POCT-TnT were judged as missed cases in primary health care. Conclusion. The use of POCT-TnT may reduce emergency referrals but probably at the cost of an increased risk to miss patients with AMI or UA.