title: Diagnostic accuracy of point-of-care testing for acute coronary syndromes, heart failure and thromboembolic events in primary care: a cluster-randomised controlled trial.
abstract: BACKGROUND
  Evidence of the clinical benefit of 3-in-1 point-of-care testing (POCT) for cardiac troponin T (cTnT), N-terminal pro-brain natriuretic peptide (NT-proBNP) and D-dimer in cardiovascular risk stratification at primary care level for diagnosing acute coronary syndromes (ACS), heart failure (HF) and thromboembolic events (TE) is very limited. The aim of this study is to analyse the diagnostic accuracy of POCT in primary care.
  
  
  METHODS
  Prospective multicentre controlled trial cluster-randomised to POCT-assisted diagnosis and conventional diagnosis (controls). Men and women presenting in 68 primary care practices in Zurich County (Switzerland) with chest pain or symptoms of dyspnoea or TE were consecutively included after baseline consultation and working diagnosis. A follow-up visit including confirmed diagnosis was performed to determine the accuracy of the working diagnosis, and comparison of working diagnosis accuracy between the two groups.
  
  
  RESULTS
  The 218 POCT patients and 151 conventional diagnosis controls were mostly similar in characteristics, symptoms and pre-existing diagnoses, but differed in working diagnosis frequencies. However, the follow-up visit showed no statistical intergroup difference in confirmed diagnosis frequencies. Working diagnoses overall were significantly more correct in the POCT group (75.7% vs 59.6%, p = 0.002), as were the working diagnoses of ACS/HF/TE (69.8% vs 45.2%, p = 0.002). All three biomarker tests showed good sensitivity and specificity.
  
  
  CONCLUSIONS
  POCT confers substantial benefit in primary care by correctly diagnosing significantly more patients.
  
  
  BACKGROUND
  DRKS: DRKS00000709.
authors: European Center of Pharmaceutical Medicine, University of Basel, 4051 Basel, Switzerland.
authors: Yuki
authors: Y
authors: Tomonaga
authors: Felix
authors: F
authors: Gutzwiller
authors: Thomas F
authors: TF
authors: Lüscher
authors: Walter F
authors: WF
authors: Riesen
authors: Markus
authors: M
authors: Hug
authors: Albert
authors: A
authors: Diemand
authors: Matthias
authors: M
authors: Schwenkglenks
authors: Thomas D
authors: TD
authors: Szucs
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood* / Q000175:diagnosis; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D016000:Cluster Analysis; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism*; D006333:Heart Failure / Q000097:blood* / Q000175:diagnosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D019095:Point-of-Care Systems / Q000592:standards*; D011320:Primary Health Care; D011446:Prospective Studies; D015203:Reproducibility of Results; D012307:Risk Factors; D013923:Thromboembolism / Q000097:blood* / Q000175:diagnosis; D020107:Troponin T / Q000097:blood*
chemical_list: D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; D010446:Peptide Fragments; D020107:Troponin T; C036309:fibrin fragment D; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain