New protocol for chest pains could prevent 50,000 hospitalizations per year

A new protocol for chest pains developed by scientists at Radboudumc in Nijmegen could reduce the number of patients entering the emergency room by tens of thousands each year. The Nijmegen scientists developed a method to safely let patients with a low risk of a heart attack stay at home instead of being hospitalized, the Volkskrant reports.

Every year, some 200,000 people in the Netherlands call an ambulance because of chest pains. The protocol for GPs and ambulance staff currently says they should go straight to the emergency room because chest pain could indicate a heart attack. But in the hospital, 80 to 90 percent of patients turn out to be okay.

Cardiologist Cyril Camaro and his colleagues, therefore, developed a new protocol. First responders determine whether the patient is at high or low risk of a heart attack by listening to the patient’s description of what happened, making an ECG, and considering factors like age and lifestyle. A high-risk patient goes straight to the emergency room. With low-risk patients, the paramedics measure the level of troponin in their blood - something that recently became possible outside hospitals thanks to advancing technology. Troponin is a protein released during heart damage. So high troponin levels mean straight to the hospital, while low levels mean the patient can stay at home.

The Radboudumc researchers tested the protocol on 863 low-risk patients, half of whom were hospitalized according to the old method, and the other half stayed at home. The risk of severe heart disease in the month after the chest pains was negligible for both groups - 0.5 for the patients who stayed home and 1 percent for those who went to the hospital.

“We show that this way of working is safe for the patient and also much more pleasant. In an ambulance and at the emergency room, you will have to deal with all kinds of bells and whistles. Often people cannot work for one or two days. You end up in a hospital, an intense experience,” Camaro said to the newspaper. Despite the extra tasks for ambulance employees, the method also doesn’t keep ambulances occupied for much longer than a trip to the emergency room. Most ambulances were quickly available again.

More at-home treatment will also relieve pressure from emergency rooms, Camaro said. “At a conservative estimate, this way of working saves one in four heart aid admissions, which is 50,000 patients per year.” If this protocol is introduced throughout the Netherlands, it could save 48 million euros in healthcare costs, he calculated.