POCT-assisted Diagnosis for Acute Coronary Syndrome, Heart Failure and Venous Thromboembolism in Primary Care: A Longitudinal Analysis
|Claudia Steiner1, Thomas D Szucs2*, Markus Hug3, Walter F Riesen4 and Yuki Tomonaga5|
|1Institute of Anaesthesiology and Intensive Care Medicine, Kantonsspital, 8501 Frauenfeld, Switzerland|
|2Institute of Pharmaceutical Medicine ECPM, University of Basel, 4057 Basel, Switzerland|
|3FMH Foederatio Medicorum Helveticorum (Swiss Medical Association), 2800 Delémont, Switzerland|
|4Institute of Clinical Chemistry and Haematology, Kantonsspital, 9007 St. Gallen, Switzerland|
|5Institute of Social and Preventive Medicine, University of Zurich, 8001 Zürich, Switzerland|
|Corresponding Author :||Thomas D Szucs
Department of Pharmaceutical Medicine
University of Basel, 4057 Basel, Switzerland
Tel: +41 61 265 76 50
Fax: +41 61 261 76 55
E-mail: [email protected]
|Received January 24, 2015; Accepted April 21, 2015; Published April 28, 2015|
|Citation: Steiner C, Szucs TD, Hug M, Riesen WF, Tomonaga Y (2015) PPOCTassisted Diagnosis for Acute Coronary Syndrome, Heart Failure and Venous Thromboembolism in Primary Care: A Longitudinal Analysis. J Gen Pract S1-003. doi: 10.4172/2329-9126.S1-003|
|Copyright: © 2015 Steiner C, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.|
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Objective: Evaluating symptoms indicating acute Coronary Syndrome (ACS), Heart Failure (HF) or Venous Thromboembolism (VTE) poses a particular challenge at primary care level. Cardiac troponin T (cTnT), N-terminal pro-brain natriuretic peptide (NT-proBNP) and D-dimer serve as crucial diagnostic tools in such assessments. Evidence of the clinical benefit of 3-in-1 Point-of-Care Testing (POCT) for these biomarkers are very limited. The current study is to further investigate the benefit of POCT-assisted diagnosis for cardiovascular risk stratification in primary care.
Methods: In the first phase of a previously reported prospective multicentre controlled trial, primary care physicians were randomised to POCT assisted diagnosis or conventional diagnosis (controls). In the second phase, the controls received the POCT analyser and continued patient recruitment. The accuracy of the working diagnosis made during the baseline consultation of adults presenting with the respective symptoms was evaluated in a followup examination. The resulting accuracy was compared with the accuracy from the controls.
Results: Controls and POCT patients were similar in terms of baseline characteristics, symptoms and pre-existing diagnoses, but differed in working diagnosis frequencies. After the follow-up visit, except for the musculoskeletal problems, which were more prevalent in the controls, no statistically significant difference could be determined in regard to the confirmed diagnosis frequencies. In the POCT group, working diagnoses were more frequently correct (79.2% vs. 59.6%, p<0.001) and diagnostic accuracy for ACS, HF, and VTE was higher (58.3% vs. 45.2%, p<0.001).
Conclusion: The POCT device improved the diagnostic accuracy for patients with symptoms indicative of ACS, HF, or VTE.