Acute & General Medicine, 21- 22 November 2017, EXCEL LONDON

EUROPE’S MUST ATTEND CLINICAL TRAINING
CONFERENCE FOR ALL HOSPITAL DOCTORS 

12-13 NOVEMBER 2019, EXCEL LONDON

HOSTING THE EUROPEAN ACUTE CARE CONFERENCE

EACC

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2018 Seminar Programme

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Early diagnosis of acute coronary syndromes

Streams: Emergency Medicine
Chest pain accounts for approximately 6% of Emergency Department (ED) attendances and is the most common reason for emergency hospital admission. For many years, our approach to diagnosis has required patients to stay in hospital for at least 6–12 h to undergo serial biomarker testing. As less than one fifth of the patients undergoing investigation actually has an acute coronary syndrome (ACS), there is tremendous potential to reduce unnecessary hospital admissions.
Recent advances in diagnostic technology have improved the efficiency of care pathways. Decision aids such as the Thrombolysis in Myocardial Infarction (TIMI) risk score and the History, Electrocardiogram, Age, Risk factors and Troponin (HEART) score enable rapid ‘rule out’ of ACS within hours of patients arriving in the ED. With high sensitivity cardiac troponin (hs-cTn) assays, approximately one third of patients can have ACS ‘ruled out’ with a single blood test, and up to two thirds could have an acute myocardial infarction ‘ruled out’ with a second sample taken after as little as 1 h.
This talk will summarise some of those recent advances, as well as presenting an overview of the principles behind the development of a novel decision aid: Troponin-only Manchester Acute Coronary Syndromes (T-MACS). This clinical prediction model could be used to ‘rule out’ and ‘rule in’ ACS following a single blood test and to calculate the probability of ACS for every patient. The future potential of this approach is then addressed, including practical applications of artificial intelligence, shared decision making, near-patient testing and personalized medicine.

Learning outcomes:
  • To understand the limitations of traditional approaches to ACS diagnosis
  • To understand the novel algorithms that enable expedited ‘rule in’ and  ‘rule out’ of acute coronary syndromes
  • To understand future possibilities for further development of these algorithms.

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