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New chest pain test for rural hospitals and general practices

Research into more effective treatment for rural residents experiencing chest pain shows real benefits.

In 2018, the Heart Foundation supported Dr Rory Miller, University of Otago Senior Lecturer and Director Rural Postgraduate Programme, with a Project Grant to look into the use of Accelerated Chest Pain Pathways in rural hospitals and general practices. This pathway is already in all emergency departments in urban New Zealand.

Chest pain is a common reason patients present to an emergency department. In rural communities, however, a lack of chest pain assessment methods (pathways) has meant that low-risk patients have needlessly travelled significant distances to urban hospitals to receive the proper tests. Part of this assessment method is to test for troponin. Troponin is a protein found in the muscles of your heart, but only when heart muscles become damaged.

Generally, only urban medical facilities can carry out the troponin test with enough accuracy. This has meant that implementation of the chest pain pathway hasn’t happened in many of New Zealand’s rural hospitals and general practices.

The advantage of implementing the pathway in rural hospitals and general practices is that patients who aren’t having a heart attack can be safely discharged from the emergency department sooner without travelling long distances to urban facilities.

Rory’s team evaluated the safety and effectiveness of the accelerated chest pain pathway, including a troponin test performed in rural settings.

In the study, more than half the patients were safely managed in rural communities without transportation to larger urban hospitals. Most importantly, during the study, none of the patients had adverse heart events following discharge.

“As far as we know, this is the first study of its kind in a rural environment, anywhere in the world,” says Rory.

“All 27 locations involved in the study have adopted our pathway, and several other rural and smaller urban practices are also looking into it. This includes prison services where moving patients require extra resources or difficulty.”

Rory hopes to see the accelerated pathway adopted across the board to reduce the impact on people living in rural environments. The challenge at this stage is that two tests are required with a two-hour delay between them. However, his team hopes that technological advances will result in patients arriving at emergency rooms and receiving a single test to rule out a heart attack.

The pathway removes unnecessary time and stress for those patients not experiencing a heart attack. It also means that patients that are can be identified quicker, and the resources utilised better.

Following the pilot study with the support of the Heart Foundation, Rory has now received funding from the Health Research Council to continue the evaluation of the pathway for patients presenting with chest pain.

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