A randomized trial of a 1-hour troponin T protocol in suspected acute coronary syndromes: design of the rapid assessment of possible ACS in the emergency department with high sensitivity troponin T (RAPID-TnT) study

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dc.contributor.authorPapendick, C.
dc.contributor.authorBlyth, A.
dc.contributor.authorSeshadri, A.
dc.contributor.authorEdmonds, M.
dc.contributor.authorBriffa, T.
dc.contributor.authorCullen, L.
dc.contributor.authorQuinn, S.
dc.contributor.authorKarnon, J.
dc.contributor.authorChuang, A.
dc.contributor.authorNelson, A.
dc.contributor.authorHorsfall, M.
dc.contributor.authorMorton, E.
dc.contributor.authorChew, D.
dc.date.issued2017
dc.description.abstractBackground: Protocols incorporating high-sensitivity troponin to guide decision making in the disposition of patients with suspected acute coronary syndromes (ACS) in the emergency department have received a lot of attention. Traditionally, patients with chest pain have required long periods of observation in emergency department before being deemed safe for discharge. In an era of limited health service resources, a protocol that could discharge patients safely within an hour of presentation is extremely attractive. Unfortunately, despite incorporation into some guidelines, these protocols have not been subjected to randomized comparisons evaluating safety, effectiveness, and cost-effectiveness. Objective: This study is designed to provide the evidence required to allow key decision makers to implement these protocols: specifically, to provide evidence that a decision rule based on 0- and 1-hour high-sensitivity troponin T (hs-TnT) is safe, provides noninferior outcomes in all patients with suspected ACS, and that implementation of a rapid troponin protocol leads to efficient care. Design: This prospective pragmatic trial (n = 5,400, 5 hospitals) randomly allocates patients with suspected ACS to either a 0/1-hour hs-TnT protocol as advocated in clinical guidelines, versus usual care of standard troponin reporting evaluated at 3 and 6 hours. The primary effectiveness composite end points of this study are all-cause death and new/recurrent ACS within 30 days. To evaluate cost-effectiveness, follow-up will determine clinical events, quality of life, and resource utilization within 12 months. Summary: Demonstrating that a 0/1-hour hs-TnT protocol improves the effectiveness and efficiency of care within a robust comparative study will fill an evidence gap that currently limits the translation of more precise hs-TnT testing into better patient and health service outcomes.
dc.description.statementofresponsibilityCynthia Papendick, Andrew Blyth, Anil Seshadri, Michael J. R. Edmonds, Tom Briffa, Louise Cullen, Stephen Quinn, Jon Karnon, Anthony Chuang, Adam J. Nelson, Matthew Horsfall, Erin Morton and Derek P. Chew
dc.identifier.citationAmerican Heart Journal, 2017; 190:25-33
dc.identifier.doi10.1016/j.ahj.2017.05.004
dc.identifier.issn0002-8703
dc.identifier.issn1097-6744
dc.identifier.orcidEdmonds, M. [0000-0001-7524-4374]
dc.identifier.orcidKarnon, J. [0000-0003-3220-2099]
dc.identifier.orcidNelson, A. [0000-0003-0990-2548]
dc.identifier.urihttp://hdl.handle.net/2440/111070
dc.language.isoen
dc.publisherElsevier
dc.relation.granthttp://purl.org/au-research/grants/nhmrc/1124471
dc.rightsCrown Copyright © 2017 Published by Elsevier Inc. All rights reserved.
dc.source.urihttps://doi.org/10.1016/j.ahj.2017.05.004
dc.subjectHumans
dc.subjectDisease Progression
dc.subjectTroponin T
dc.subjectElectrocardiography
dc.subjectIncidence
dc.subjectCause of Death
dc.subjectSurvival Rate
dc.subjectRisk Assessment
dc.subjectFollow-Up Studies
dc.subjectProspective Studies
dc.subjectTime Factors
dc.subjectQuality of Life
dc.subjectMiddle Aged
dc.subjectEmergency Service, Hospital
dc.subjectAustralia
dc.subjectFemale
dc.subjectMale
dc.subjectAcute Coronary Syndrome
dc.titleA randomized trial of a 1-hour troponin T protocol in suspected acute coronary syndromes: design of the rapid assessment of possible ACS in the emergency department with high sensitivity troponin T (RAPID-TnT) study
dc.typeJournal article
pubs.publication-statusPublished

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