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Potential to improve diagnostic process and treatment pathways


10 May, 2016  

Philips’ cardiology expertise delivers Troponin I point-of-care test in the acute care setting

Veronique Semjonow MD

Medical Director, Philips Handheld Diagnostics

Ischaemic heart disease is the most common cause of death in most Western countries, with the incidence steadily rising.  By 2030, it is forecasted that more than 23 million people globally will die annually of some type of cardiovascular disease.1 As one of the global leaders in cardiology care, Philips already provides powerful tools for the diagnosis and management of your patients presenting with both chronic conditions and acute cardiac events.
 
In the acute setting, when time is critical for a patient’s life, you need to make accurate clinical decisions rapidly. The Philips diagnostic ECG enables you to identify patients with ST-elevation myocardial infarction (STEMI) so they can be prioritised for the catheterisation laboratory.  However, for the majority of patients presenting to the Emergency Department (ED) with suspicion of acute coronary syndrome (ACS), there is no consistent ST-elevation.  The diagnosis is then supported by serial testing for raised levels of the cardiac marker troponin, with a rise or a fall of the value;2 but it currently takes up to 60 minutes for troponin results to come back from the lab.  
 
Fast rule-in, rule-out of ACS in acute setting
For patients suspected of ACS, time-to-decision making would be significantly reduced if you were able to measure troponin levels simultaneously with the ECG.   Emergency physicians throughout the world have consistently advised Philips that they would welcome a sensitive and robust troponin POC assay that delivers lab comparable results by the side of the patient, directly from a drop of blood; and to have those results within 10 minutes.  
 
Philips plans to launch the Minicare I-20 in vitro diagnostics point-of-care system this year (in selective European markets in 2016), with a cardiac Troponin I (Minicare cTnI) assay for use in the Emergency Department to rule-in and rule-out non-ST-elevation myocardial infarction (NSTEMI).  For those patients with suspected NSTE-ACS, it is intended that Minicare cTnI will provide you with the means to quickly and accurately measure their troponin levels, from a droplet of blood. Minicare cTnI is the first of several markers for emergency care that will be available on the innovative Minicare I-20 POC platform (www.philips.com/minicare).  
 
Reducing the ‘time to result’, or turnaround time (TAT), from 60 to less than 10 minutes has the potential to increase operational efficiency, while improving the quality of the overall patient care. As well as a fast rule-in, the Minicare cTnI assay is also being developed with the goal of allowing a safe three-hour rule-out protocol. 
 
Improved workflow and quality of care
The priority for any busy emergency department is to significantly reduce the turnaround time for blood test results that inform acute care diagnostic decisions.  This would be of immediate benefit to high-risk patients who may be required to wait. However, any delay in diagnosis distresses patients and adds to the pressure on staff trying to manage patient flow in the ED.  
 
This was reinforced by emergency physicians in a recent randomised study, which showed that POC testing would be associated with a significant increase in successful discharge and reduced crowding.3 The benefit of near-patient biomarker testing in the acute care setting was also one of the topics of the Philips Symposium at the 2015 Congress of the European Society for Emergency Medicine (EuSEM).  
 
Meeting participants welcomed the healthcare improvements this technology would open up.  They predicted that the total length of stay in the ED would be reduced if you could initiate treatment for some patients more quickly, or have the added confidence of discharging others to out-patient follow up.  However, during the seminar, it was also noted that it was not only the reduction in analysis time that makes point-of-care testing attractive.  It is the opportunity it offers for improving the diagnostic process and the overall quality of patient care.
 
Clinically significant info, within 10 minutes
In emergency medicine, time is often critical and you need accurate, clinically significant blood test results as rapidly as possible.  Even in high stress situations like this, Philips Minicare I-20 has the ability to provide accurate diagnostic information at the side of the patient.   When ACS is suspected, Minicare cTnI enables you to measure a patient’s troponin level simultaneously with an ECG.  You no longer need to send blood to the lab or wait an hour for the result. When Troponin I is run on the Minicare I-20, the development goal is to deliver lab comparable results from a droplet of blood – within 10 minutes; with the sensitivity to allow a safe three-hour rule-out protocol.
 
Delivering faster results can potentially reduce crowding, enabling the department to handle patient numbers more efficiently.  In turn, this could significantly improve the patient experience; and their satisfaction with the quality of the care they are receiving.   
 
 
Minicare I-20 for the acute care setting
 
Improved near patient diagnostic process
  • Lab comparable results within 10 minutes
  • Diagnostic accuracy from a finger prick of whole blood
  • Faster diagnosis of Acute Coronary Syndrome (ACS)
  • Minicare cTnI assay sensitivity will allow for safe three-hour rule-out protocol
 
Rapid results and operational efficiency
  • Troponin test TAT down from 60 minutes to less than 10 minutes
  • On the spot, clinically significant information enhances patient care
  • Reduces ED crowding
  • Improves patient workflow
 
Easy to use system with unique integrated quality control
  • Easy to use  by staff beyond the lab, including ED and paramedics 
  • Connectivity for faster data sharing 
  • Flexible sample handling: droplet of capillary or venous whole blood 
  • Built-in RFiD technology containing QC assay data
  • Results reliability with no need for QC runs
 
Discover more at www.philips.com/minicare
 
 
References
  1. World Health Organization. About cardiovascular diseases. 2016. www.who.int/cardiovascular_diseases/about_cvd/en/ (accessed March 2016).
  2. Thygesen K et al. Joint ESC/ACCF/AHA/WHF Task force. Third universal definition of myocardial infarction. Circulation 2012;126(16):2020–35.
  3. Bingisser R et al. Cardiac troponin: a critical review of the case for point-of-care testing in the ED. Am J Emerg Med 2012;30(8):1639–49.