The £10 Heart Attack Test Which Could Save Thousands of Lives

A new £10 blood test which can detect heart attack in the first 30 minutes, could save thousands of lives. The test developed by British scientists can identify patients suffering with a heart attack almost on arrival at A&E. The simple check can also accurately rule out those who come to hospital with chest pains cause by other problems.

Acute chest pain is estimated to be responsible for around 800,000 visits to Emergency Departments in the UK every year, costing upwards of £500 million and one of the biggest challenges facing A&E doctors is how to prioritise people presenting with chest pain; this new test offers an effective solution.

The revolutionary test, developed by global diagnostics firm Randox Laboratories, seeks out a protein in the blood called H-FABP (Heart Type Fatty Acid Binding Protein). This is released during the early stages of an attack and because it is so small, it can be detected when the heart cells are being damaged – rather than when they are necrotic.

H-FABP can also be detected quickly – as early as 30 minutes after the onset of heart attack, tests used by the NHS, including a ‘new’ higher sensitivity test (Troponin) can take up to 6 hours to provide confirmation, by which time cell death may have occurred.

RULES OUT HEART ATTACK

The value of H-FABP is not just in positive diagnosis – but doctors are beginning to see it as a means of ‘ruling out heart attack’ when a patient presents at A&E with chest pain.

Dr. Rick Body a consultant in Emergency Medicine at Manchester Royal Infirmary has extensively researched the use of H-FABP as a diagnostic tool, particularly during the early hours after the onset of heart attack like symptoms. Dr Body believes that H-FABP could have a significant impact on how chest pain patients are managed within EDs:

"Recent trials have shown that using H-FABP as an addition to an existing troponin test offers the potential to rule-out heart attack in many patients as early as their time of presentation to hospital. This means doctors will have a more accurate insight into who is actually at risk of heart attack and how to make the best use of resources. Many patients with chest pain are admitted to hospital for hours or even days to have further tests, although most of them don't have a heart problem and don't need to stay in hospital to have treatment of their condition. These patients could have been reassured much earlier, avoiding hospital admission, if we had better tests. If this new combination of tests could be successfully rolled out in Emergency Departments we could bring almost instant peace of mind to those who are not suffering a heart attack and prioritise those who are."

The test has been created by UK diagnostics company, Randox Laboratories, who hope it will be used to identify patients at risk and allow for lifesaving treatment, Gary Smyth Medical Director at Randox Laboratories, hopes the test will become widely available so that doctors can identify and priortise patients at risk:

“Despite the best efforts of our NHS colleagues, EDs across the UK are under tremendous pressure. In many cases people presenting with chest pain aren’t suffering a heart attack, and current cardiac tests are not as sensitive as clinicians would like, resulting in many patients being admitted unnecessarily, taking up beds and using valuable resources. However if the H-FABP test was added to existing tests on arrival at hospital, doctors could quickly and accurately rule out those patients who are not having a heart attack, allowing resources to be focused on those who are actually at high risk.”

PROGNOSTIC VALUE

Research has also shown that has shown that the higher the concentration of the H-FABP protein in the blood of a heart attack patient; the more likely it is that the patient will suffer another heart attack and/or die, within the year.

An independent study published in the Journal of American College of Cardiology, carried out by the Leeds Institute for Genetic, Health & Therapeutics; tested 1500 patients who were admitted to Leeds General Infirmary, suffering with Acute Coronary Syndrome (Heart attack). The researchers examined H-FABP levels in the blood, as well as troponin; the biomarker traditionally used in the NHS to diagnose a heart attack, they then tracked the patients for a year and found that:

Patients who tested positive for troponin but negative for H-FABP had only a 4% chance of dying within the year. However in those patients who tested negative for troponin but positive for H-FABP, the likelihood of death within 12 months had risen to more than 20%.

The research was led by internationally renowned cardiologist Professor Alistair Hall:

“Presently, where Troponin is used on its own and generates a negative result, patients are frequently sent home, however, our study found that a significant number of these people are subsequently found to be at high risk of having a heart attack over the coming months, if they have not done so already. H-FABP can help to identify these high risk patients.”

RISK OF MORTALITY IN THE NEXT 6 YEARS

The same team conducted further research into these patients and determined that a staggering 60% of those with high H-FABP levels had died within 6 years of their initial arrival to hospital with chest pain; worryingly these same patients tested negative for troponin. The scientists concluded that “Mortality rate was independent of troponin status but strongly related to H-FABP status”.

Dr Peter FitzGerald MD at Randox Laboratories says the test is essential for preventing mortality in patients following a heart attack:

“Testing for H-FABP when patients arrive at hospital with chest pain, is the key to identifying those at long term high risk. Research shows that troponin alone, currently used in the NHS does not pick up on a significant number of these high risk patients who then miss out on life saving treatment. Indeed, the research shows that even patients who were troponin negative, but, H-FABP positive were at high risk of death. If H-FABP were added to the testing regime, clinicians could ensure that these patients are not missed but are identified and treated effectively.”