Improving the Management of Acute Coronary Syndromes in the Emergency Department

Study Overview
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Brief Summary
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By using a Rapid Cardiac Evaluation (RACE) pathway in the Emergency Department (ED), the investigators can effectively reduce ED wait times and ED length of stay by decreasing overall hospital admissions and telemetry admissions. In addition, the investigators hypothesize a decrease in mortality of those patients admitted for cardiac evaluation by increasing the patient to health care provider ratio.

Official Title
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Improving the Management of Acute Coronary Syndromes in the Emergency Department Using a Rapid Acute Cardiac Evaluation Pathway

Conditions
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Acute Coronary Syndrome

Intervention / Treatment
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* Device: Point of Care testing


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Chief complaint of chest pain 35 years old or greater Exclusion Criteria: ST elevation MI New Left Bundle Branch Block Admission regardless of test result Leaving ED against medical advice

Ages Eligible for Study
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Minimum Age: 35 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Diagnostic
Allocation: Randomized
Intervention Model: Single Group Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Core Laboratory<br>Patients receiving serial routinely available cardiac biomarker testing in a core laboratory setting using Troponin T. (Roche Centaur) | |
| Active Comparator: Point of Care<br>Patients will receive the Point of Care testing intervention using serial cardiac biomarker testing at the bedside including myoglobin, Troponin I and CK-MB. (Triage Cardiac Panel, Alere) | Device: Point of Care testing<br>* The investigators will implement 6 months of randomized testing periods, 2 weeks each. During this 2 week block, cardiac biomarkers will be tested at the bedside in the ED using the Triage Cardiac Panel that will test for CK-MB, Myoglobin, and Troponin I. Each blood sample that is take for point of care testing will be saved. The plasma from the saved sample will be frozen and the sample will be sent to an off-site testing center for high sensitivity troponin testing. All patients will be followed at the 30-day mark and those patients who are discharged home from the ED will be followed within 48 hours as well.<br>* Other names: Triage Cardiac Panel by Alere;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| ED length of stay | From patient check-in time to patient admit or discharge time | Average of 3 hours stay in the Emergency Department | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Mortality rate of admitted patients | Average hospital stay 3 days. | During hospital admission and at 30 days | 
| Hospital Admission Rate | Observing the rate at which physicians admit patients to the hospital. | Baseline | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Acute Coronary Syndrome, Cardiac Biomarkers, point of care testing