Currently it can be difficult for paramedics to accurately determine whether a patient suffering from chest pain is at risk of having a heart attack. The Chest Pain Diagnosis project, part of the Health Innovation Accelerator programme, aims to improve care for patients receiving an emergency ambulance response for acute chest pain by providing paramedics with access to a point-of-care test that determines whether a patient is at risk of having a heart attack within minutes.

The ‘Troponin-only Manchester Acute Coronary Syndromes (T-MACS) decision aid’ is a computerised clinical prediction model which calculates each individual patient’s probability of acute coronary syndromes following a single blood test. This test works well in the emergency department, but now the team at North West Ambulance Service (NWAS) are looking to implement this test into their support offer for patients across the region.

According to British Heart Foundation (BHF) figures 127 people from every 100,000 die before their 75^th birthday in Manchester from cardiovascular conditions including heart attacks, meaning Greater Manchester has one of the worst rates of premature death from cardiovascular disease in the UK.

The ambition for this project is that through the point-of-care test, paramedics will be able to accurately identify patients that are suffering from a heart attack, allowing them to receive earlier, more personalised treatment when they arrive in hospital. The longer-term aim is to prevent people being taken to hospital if they don’t need emergency treatment, freeing up ambulance resources to attend to other life-threatening incidents.

Chris Marsden and Phil Jones, Clinical Innovation Consultants at North West Ambulance Service (NWAS) have been working with partner organisations and paramedics to launch this pilot within the community. Chris said: “We are excited because point-of-care blood testing is a relatively new concept for paramedics. This pilot will determine whether pre-hospital high-sensitive troponin testing can deliver tangible benefits. This innovative collaboration is just one example of the efforts NWAS is making to deliver the right care, at the right time, in the right place, every time.”

Prof. Richard Body, Professor of Emergency Medicine; Director of Research & Innovation at Manchester University NHS Foundation Trust (MFT) has been instrumental in leading on work to assess patients for chest pain across Greater Manchester. He believes that this project will make a huge difference to the standard of diagnosis: “We have made great advances in the emergency department in terms of how quickly we can make a diagnosis for patients with chest pain. The next big challenge is to move into a pre-hospital environment, and we could be one of the first in the world to get this up and running.

“I’m also excited about the potential for changing and improving patient care because now there are real challenges in the urgent and emergency care (UEC) system. We all know about the pressures on ambulances; response times are getting higher and higher, emergency departments are more and more crowded, and we’ve got to think about new ways to deliver care that is patient centred, convenient and maintains safety, and this technology allows us to do that for an important group of patients.

“Using this technology, we can provide more individual and tailored care to patients, and we can take the patients to the right place the first time, provide specialist treatment faster and support them extremely well throughout the process.”

Caroline Dykeman, Senior Clinical Lead Innovation (RN) – Clinical Office at Health Innovation Manchester said: “This project is truly groundbreaking in the fact that this technology will enable us in a community setting to identify with a high degree of certainty the people who are and also importantly those who are not experiencing a type of heart attack called a non-ST elevation myocardial infarction. Currently this can only be determined in a hospital environment. This earlier pre-hospital identification will support one of our core aims in healthcare to ‘Get It Right First Time’ that is, to ensure that our shared decision making translates into patients accessing the right place and receiving the right care, first time, every time.”

The Chest Pain Diagnosis project is delivered by Health Innovation Manchester in partnership with Manchester University NHS Foundation Trust (MFT), North West Ambulance Service (NWAS), Siemens Healthineers, and The Greater Manchester and Eastern Cheshire Cardiovascular Strategic Clinical Network. The funding for this project has been awarded by Innovate UK as part of the Health Innovation Accelerator programme.

Prof. Richard Body, believes that this collaborative working is vital to the success of innovate work across our health and social care system: “A lot of partners have been and need to be involved – you’ve got the more regional partners like the Greater Manchester cardiac network for example. They need to be involved because this is important, and it needs to be considered how we might deliver this technology on a regional level going into the future. So, there’s a huge number of stakeholders, as it’s a very complex project and that’s why it’s so important that we got the funding that we have through this programme to deliver it, because I don’t think we could have done it without that support from all stakeholders involved.”

Lynsey Dunn, Interim Head of Digital Intelligence and Development at North-West Ambulance Service (NWAS) said: “I think it’s an exciting project for NWAS because it’s an opportunity to bring together our clinical innovation team with some quality improvements and methodology. Obviously to work with partners across Greater Manchester in our health and are sector and collaborate like this is exciting. The ambulance services are looking at the opportunity to see what impact this pilot could potentially bring to them and patients, mainly in terms of reducing secondary transfers to hospitals, and to improve the patient experience.”