Chest Pain Management Using Prehospital Point-of-Care Troponin and Paramedic Risk Assessment

Clinical question: Could paramedic risk stratification and point-of-care troponin testing result in cost savings for acute chest pain care at a population level?

What is known: Acute chest pain accounts for 10% of ambulance attendances and is associated with significant health care costs and resource utilization and recent  studies have shown that paramedics can safely perform point-of-care troponin testing and risk stratification for patients with suspected acute coronary syndrome (ACS), which reduces ED length of stay.

Methods: The outcome was estimated mean annualized statewide costs for acute chest pain. Between May 17 and June 25, 2022, decision tree models were developed to estimate costs under 3 pathways: (1) existing care, (2) paramedic risk stratification and point-of-care troponin testing without prehospital discharge, or (3) prehospital discharge and referral to a virtual emergency department (ED) for low-risk patients.

Results: A total of 188 551 patients attended by ambulance for chest pain (mean [SD] age, 61.9 [18.3] years; 50.5% female; 49.5% male; Indigenous Australian, 2.0%) were included in the model. Estimated annualized infrastructure and staffing costs for the point-of-care troponin pathways, assuming a 5-year device life span, was $2.27 million for the pathway without prehospital discharge and $4.60 million for the pathway with prehospital discharge (incorporating virtual ED costs).

Bottom-line:  Prehospital point-of-care troponin and paramedic risk stratification for patients with acute chest pain could result in substantial cost savings.