Claudia Steiner1, Thomas D Szucs2*, Markus Hug3, Walter F Riesen4 and Yuki Tomonaga5
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.
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