Reducing hospital admissions for suspected heart attacks

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Around 350,000 people are admitted to hospital each year suspected of having had a heart attack. Yet, only around 1 in 5 actually have a heart attack. Each year this results in thousands of people spending unnecessary time in hospital beds waiting to find out if they’ve suffered a cardiac event.

University of Sheffield research has led to changes in NICE guidelines which improves how clinicians test suspected heart attack patients. The result is a quicker diagnosis leading to huge economic savings.

The problem: high volume of costly hospital admissions

Troponin, a protein involved in muscle contraction, is released when the heart is damaged. For example, when a person endures a heart attack. A conventional troponin test has been used for the last 20 years. It’s designed to detect the protein in the blood after a suspected cardiac event to identify whether or not a patient has in fact had a heart attack.

But, the test takes 12 hours to produce reliable results. So for the conventional Troponin test, patients who’ve had a suspected cardiac event have to be admitted to hospital. This equates to around £400 for the one day stay required to rule out a heart attack.

Professor Steve Goodacre is the Director of Research and the University of Sheffield’s School of Health and Related Research. He’s led work on examining the relative costs and benefits of conventional and high sensitivity troponin tests.

Our solution: A change to NICE guidelines

With a high sensitivity test, troponin is detected in the blood within four hours. But the longer clinicians wait after a patient has had a heart attack the more likely they are to detect it with a test. This is due to the peak build up of troponin in the blood occurring after approximately 12 hours. Admitting people to hospital will detect more heart attacks, but it may not be cost-effective to admit lots of people to detect only a few heart attacks.

“We want to know whether it is cost effective to admit people to hospital. So we modelled the cost of admitting people to hospital compared with doing the high sensitivity tests and sending them home earlier,” explains Professor Goodacre.

Professor Goodacre’s research demonstrated that in terms of trade-off, it’s not cost effective to admit people to hospital if a high sensitivity test can be used to rule out a heart attack earlier. The National Institute of Health and Care Excellence (NICE) used this crucial piece of evidence to change the guideline on heart attack testing.

Within the guideline, NICE states: ‘The increased sensitivity of these assays could mean a shorter inpatient hospital stay for people without raised levels of troponin and earlier intervention for those with a confirmed NSTEMI [heart attack].’

“This is about value for money. It's getting the best value for your health care resources. If you've only got limited health care resources, it’s better to spend them on high sensitive troponin to allow people to go home early rather than spending those precious resources on admitting people to hospital, because there are better things you could do with them.

It's not simply about cutting costs. It's about using the costs to achieve the best benefit.

Professor Steve Goodacre

Director of Research and the University of Sheffield’s School of Health and Related Research