Responses

Original research
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
Compose Response

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
Author Information
First or given name, e.g. 'Peter'.
Your last, or family, name, e.g. 'MacMoody'.
Your email address, e.g. higgs-boson@gmail.com
Your role and/or occupation, e.g. 'Orthopedic Surgeon'.
Your organization or institution (if applicable), e.g. 'Royal Free Hospital'.
Statement of Competing Interests

PLEASE NOTE:

  • A rapid response is a moderated but not peer reviewed online response to a published article in a BMJ journal; it will not receive a DOI and will not be indexed unless it is also republished as a Letter, Correspondence or as other content. Find out more about rapid responses.
  • We intend to post all responses which are approved by the Editor, within 14 days (BMJ Journals) or 24 hours (The BMJ), however timeframes cannot be guaranteed. Responses must comply with our requirements and should contribute substantially to the topic, but it is at our absolute discretion whether we publish a response, and we reserve the right to edit or remove responses before and after publication and also republish some or all in other BMJ publications, including third party local editions in other countries and languages
  • Our requirements are stated in our rapid response terms and conditions and must be read. These include ensuring that: i) you do not include any illustrative content including tables and graphs, ii) you do not include any information that includes specifics about any patients,iii) you do not include any original data, unless it has already been published in a peer reviewed journal and you have included a reference, iv) your response is lawful, not defamatory, original and accurate, v) you declare any competing interests, vi) you understand that your name and other personal details set out in our rapid response terms and conditions will be published with any responses we publish and vii) you understand that once a response is published, we may continue to publish your response and/or edit or remove it in the future.
  • By submitting this rapid response you are agreeing to our terms and conditions for rapid responses and understand that your personal data will be processed in accordance with those terms and our privacy notice.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.

Vertical Tabs

Other responses

  • 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...

    Show More
    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...

    Show More
    Conflict of Interest:
    None declared.