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Comparison of a single high-sensitivity cardiac troponin T measurement with the HEART score for rapid rule-out of acute myocardial infarction in a primary care emergency setting: a cohort study
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  • Published on:
    Response to letter regarding article "Comparison of a single high-sensitivity cardiac troponin T measurement with the HEART score for rapid rule-out of acute myocardial infarction in a primary care emergency setting: a cohort study"

    Dear Editor,

    We appreciate the questions and contributions by A.M Wilson and colleagues in their letter to the Editor published August 25 2021. We would like to respond to the issues raised and clarify some aspects of our methodology and research setting in relation to these questions.

    Firstly, it is essential to emphasise that the study was not conducted in general practice, but at a primary care emergency clinic (i.e., out-of-hours (OOH)-/accident and emergency clinic) staffed by general practitioners (GPs). Norway follows a similar model as described for the Netherlands, where patients with typical cardiac symptoms are directly hospitalised by the ambulance service, while patients with more atypical symptoms are referred to hospital if considered necessary by the treating physician, in most cases a GP. As most of these do not have an acute cardiac episode, these low-risk referrals contribute to increased health care utilisation and possibly unnecessary hospitalisations.(1, 2) The OUT-ACS (One-hoUr Troponin in a low-prevalence population of Acute Coronary Syndrome) study(3, 4) was conducted to explore whether a larger proportion of these low-risk patients could be assessed in emergency primary care.

    We fully agree that the retrospective calculation of the HEART scores may have introduced bias and misclassification, e.g., obesity as a risk factor was not recorded. At the same time, all remaining variables were available from the prospective study.(3...

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    Conflict of Interest:
    None declared.
  • Published on:
    Letter to the editor
    • A.M. Wilson, General practitioner University of Maastricht
    • Other Contributors:
      • A.E.D Boddeus, General practitioner
      • S. Khatibi, General practitioner
      • M. Veerman, General practitioner
      • S. Van Gestel, General practitioner

    Dear Editor,

    We have read your article entitled “comparison of a single high-sensitivity cardiac troponin T measurement with the HEART score for rapid rule-out of acute myocardial infarction in a primary care emergency setting: a cohort study”

    We would like to congratulate the authors for their interesting and clinically relevant research on early diagnosis of AMI in primary care. However, we would like to make some contributions.

    The study describes the Norwegian primary care setting.
    However our setting in the Netherlands is different, which makes it challenging to extrapolate the results to our situation.

    Firstly, in Dutch primary care, we do not have the possibility to admit patients for observation. Patients with typical cardiac symptoms are referred directly to the cardiac care unit. For patients with more atypical symptoms, referral depends on the clinical judgement of the general practitioner. Furthermore, in the Netherlands patients usually present themselves within three hours of onset of symptoms which makes a single hs-cTnT impractical in those cases.

    Secondly, concerning the study methods:
    This study design was based on a retrospective analysis from the OUT-ACS study which makes it more prone to bias.
    Additionally, we noticed that you initially recruited 11.618 patients presenting with chest pain but only 3066 were included. This is a remarkable decline in study population, which aroused the question to...

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    Conflict of Interest:
    None declared.