In an ideal world, every patient experiencing the vice-like grip of angina would be diagnosed swiftly. Yet many Thais who experience chest pains are reluctant to seek medical attention. Many delay a visit to the doctor, some even for as long as two days. Along with our nation’s changing dietary and lifestyle habits, it is little wonder then that the mortality from coronary heart disease continues to climb [1].

While laboratory medicine may have little direct influence over people’s health-seeking behaviour, we can ensure that our services provide accurate diagnoses in the shortest time possible. And we can take a leading role in delivering these time savings.

At Khon Kaen University, we reviewed the journey from arrival at a healthcare facility to treatment. We realised that after clinical assessment, there can be a delay in EKG monitoring, and more seriously, that troponin results may be delayed.

To eliminate some of these delays, we trained more healthcare professionals, including nurses, to be able to read EKG results to ensure prompt monitoring for patients.

Equally significantly, we wanted to incorporate screening for troponin T levels at the point of care so that patients at risk of a cardiac-related event or complications are triaged promptly and receive the necessary follow up care.

Evaluating the diagnostic value of point-of-care (POC) troponin T testing, researchers from Denmark reported in 2013 [2] that 89 per cent of patients with troponin T levels higher than 50ng/L suffered from a cardiac–related condition. This elevated level also corresponded to a 3-10x higher mortality rate, regardless of whether the patient had a diagnosis of an acute coronary syndrome or not.

We therefore decided to include troponin T screening because even non-ST-elevated MI patients with elevated troponin T levels face higher mortality risks and should be operated on within 24 hours.

Adding POC troponin T testing to our diagnostic service has transformed the care we provide our patients. By combining clinical evaluation of symptoms with EKG and POC troponin T, this diagnostic pathway offers value and saves lives.

[1] Kiatchoosakun, S., et al., 2012. Coronary artery disease in the Thai population: data from health situation analysis 2010. Journal of the Medical Association of Thailand, 95 supplementary 7, S149-155.

[2] Stengaard, C., et al. 2013. Quantitative Point-of-Care Troponin T Measurement for Diagnosis and Prognosis in Patients With a Suspected Acute Myocardial Infarction. The American Journal of Cardiology, 112(9), pp.1361-1366.