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• Johannessen, Tonje Rambøll; Halvorsen, Sigrun; Atar, Dan; Munkhaugen, John; Nore, Anne Kathrine & Wisløff, Torbjørn [Show all 7 contributors for this article] (2022). Cost-effectiveness of a rule-out algorithm of acute myocardial infarction in low-risk patients: emergency primary care versus hospital setting. BMC Health Services Research. ISSN 1472-6963. 22(1). doi: 10.1186/s12913-022-08697-6. Full text in Research Archive Show summary

  Aims: Hospital admissions of patients with chest pain considered as low risk for acute coronary syndrome contribute to increased costs and crowding in the emergency departments. This study aims to estimate the cost-effectiveness of assessing these patients in a primary care emergency setting, using the European Society of Cardiology (ESC) 0/1-h algorithm for high-sensitivity cardiac troponin T, compared to routine hospital management. Methods: A cost-effectiveness analysis was conducted. For the primary care estimates, costs and health care expenditure from the observational OUT-ACS (One-hoUr Troponin in a low-prevalence population of Acute Coronary Syndrome) study were compared with anonymous extracted administrative data on low-risk patients at a large general hospital in Norway. Patients discharged home after the hs-cTnT assessment were defined as low risk in the primary care cohort. In the hospital setting, the low-risk group comprised patients discharged with a non-specific chest pain diagnosis (ICD-10 codes R07.4 and Z03.5). Loss of health related to a potential increase in acute myocardial infarctions the following 30-days was estimated. The primary outcome measure was the costs per quality-adjusted life year (QALY) of applying the ESC 0/1-h algorithm in primary care. The secondary outcomes were health care costs and length of stay in the two settings. Results: Differences in costs comprise personnel and laboratory costs of applying the algorithm at primary care level (€192) and expenses related to ambulance transports and complete hospital costs for low-risk patients admitted to hospital (€1986). Additional diagnostic procedures were performed in 31.9% (181/567) of the low-risk hospital cohort. The estimated reduction in health care cost when using the 0/1-h algorithm outside of hospital was €1794 per low-risk patient, with a mean decrease in length of stay of 18.9 h. These numbers result in an average per-person QALY gain of 0.0005. Increased QALY and decreased costs indicate that the primary care approach is clearly cost-effective. Conclusion: Using the ESC 0/1-h algorithm in low-risk patients in emergency primary care appears to be cost-effective compared to standard hospital management, with an extensive reduction in costs and length of stay per patient.

• Johannessen, Tonje Rambøll; Halvorsen, Sigrun; Atar, Dan & Vallersnes, Odd Martin (2022). Performance of the Novel Observation Group Criteria of the European Society of Cardiology (ESC) 0/1-Hour Algorithm in a Low-Risk Population. Journal of the American Heart Association (JAHA). ISSN 2047-9980. 11(7). doi: 10.1161/JAHA.121.024927. Full text in Research Archive
• Chiang, Cho-Han; Chiang, Cho-Hung; Pickering, John W; Stoyanov, Kiril M.; Chew,, Derek P. & Neumann, Johannes T. [Show all 38 contributors for this article] (2021). Performance of the European Society of Cardiology 0/1-Hour, 0/2-Hour, and 0/3-Hour Algorithms for Rapid Triage of Acute Myocardial Infarction. An International Collaborative Meta-analysis. Annals of Internal Medicine. ISSN 0003-4819. doi: 10.7326/M21-1499.
• Johannessen, Tonje R.; Atar, Dan; Vallersnes, Odd Martin; Larstorp, Anne Cecilie Kjeldsen; Mdala, Ibrahimu & Halvorsen, Sigrun (2021). Comparison of a single high-sensitivity cardiac troponin T measurement with the HEART score for rapid rule-out of acute myocardial infarction in a primary care emergency setting: a cohort study. BMJ Open. ISSN 2044-6055. 11(2). doi: 10.1136/bmjopen-2020-046024. Full text in Research Archive
• Johannessen, Tonje R.; Vallersnes, Odd Martin; Halvorsen, Sigrun; Larstorp, Anne Cecilie Kjeldsen; Mdala, Ibrahimu & Atar, Dan (2020). Pre-hospital One-Hour Troponin in a Low-Prevalence Population of Acute Coronary Syndrome: OUT-ACS study. Open heart. ISSN 2053-3624. 7:e001296, p. 1–9. doi: 10.1136/openhrt-2020-001296. Full text in Research Archive

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• Johannessen, Tonje Rambøll; Vallersnes, Odd Martin; Atar, Dan; Halvorsen, Sigrun; Larstorp, Anne Cecilie Kjeldsen & Nilsen, Beate [Show all 7 contributors for this article] (2024). Rapid rule-out of acute myocardial infarction using troponins in emergency primary care: the OUT-ACS implementation study.
• Johannessen, Tonje Rambøll (2023). Anvendelse av troponin på legevakt for å utelukke akutt hjerteinfakt: OUT-ACS-studien (One-hoUr Troponin in a low-prevalence population of Acute Coronary Syndrome).
• Emilsson, Louise; Brænd, Anja Maria Lyche; Dahli, Mina; Johannessen, Tonje Rambøll & Skonnord, Trygve (2023). Designing a new elective subject for third-year medical students on navigating medical guidelines. Show summary

  Background: Understanding how to navigate medical guidelines is an essential skill for future doctors. Recent emphasis has been placed on the importance of prioritization and time management when implementing guidelines into clinical practice. However, traditional medical education is offered topic by topic, with less emphasis given to patient-centred care, grading of recommendations and sometimes conflicting guidelines. Methods: Our objective was to develop a two-week elective subject titled "The Medical Profession: Navigating Medical Guidelines" for third-year medical students in Oslo. Through an intensive application of the nominal group technique (NGT), a group of five experienced primary care physicians and teachers collaborated during a two-day session to design the subject and its curriculum. Initially, we had concerns about the complexity of this topic for students at the third-year level due to their limited clinical experience. To assess the subject, the examination was designed to include an individual reflection note and a group presentation. Out of 16 students, 14 consented to having their reflection notes used for educational research purposes. Results: The NGT process led to development of a subject with interactive lectures, group and plenary discussions, as well as a clinical rotation day. Key topics included research guidelines, sensible choices and sustainability, patient-centered care, medical uncertainty, multi-morbidity, and navigating conflicting guidelines. A longitudinal patient-case video presentation accompanied the teaching with increasing complexity each day. Students were divided into two groups for the clinical rotation day at out-of-hour emergency care and nursing home facilities. Two teachers were present each day of the course to facilitate skill development and discussions. Students provided positive feedback, appreciating the reflection on their future professional roles. Conclusion(s): The NGT process proved effective in creating an elective subject well-received by both teachers and students. We encourage others to consider using similar models when designing new curricula.

• Emilsson, Louise; Brænd, Anja Maria Lyche; Johannessen, Tonje Rambøll; Dahli, Mina & Skonnord, Trygve (2023). Development of a new elective subject for third-year students on navigating medical guidelines.
• Johannessen, Tonje Rambøll; Halvorsen, Sigrun; Atar, Dan; Munkhaugen, John; Nore, Anne Kathrine & Wisløff, Torbjørn [Show all 7 contributors for this article] (2021). Cost-minimization analysis of acute myocardial infarction rule-out in low-risk patients: emergency primary care versus hospital.
• Johannessen, Tonje Rambøll; Halvorsen, Sigrun; Atar, Dan; Munkhaugen, John; Nore, Anne Kathrine & Wisløff, Torbjørn [Show all 7 contributors for this article] (2021). Cost-minimisation analysis of acute myocardial infarction rule-out in low-risk patients: primary care emergency setting versus hospital setting.
• Johannessen, Tonje R.; Atar, Dan; Vallersnes, Odd Martin; Larstorp, Anne Cecilie Kjeldsen; Mdala, Ibrahimu & Halvorsen, Sigrun (2020). A single high-sensitivity cardiac troponin T compared to the HEART score for a rapid rule-out of acute myocardial infarction at a prehospital emergency clinic . European Heart Journal. ISSN 0195-668X. 41. doi: 10.1093/ehjci/ehaa946.1680.
• Johannessen, Tonje R.; Atar, Dan; Vallersnes, Odd Martin; Larstorp, Anne Cecilie Kjeldsen; Mdala, Ibrahimu & Halvorsen, Sigrun (2020). A single high-sensitivity cardiac troponin T compared to the HEART score for a rapid rule-out of acute myocardial infarction at a prehospital emergency clinic .
• Johannessen, Tonje R.; Vallersnes, Odd Martin; Larstorp, Anne Cecilie Kjeldsen; Mdala, Ibrahimu; Atar, Dan & Halvorsen, Sigrun (2020). Fast prehospital rule-out using a high-sensitivity cardiac Troponin T assay in a low-prevalence population for Acute Coronary Syndrome (The OUT-ACS study).
• Johannessen, Tonje R.; Vallersnes, Odd Martin; Halvorsen, Sigrun; Larstorp, Anne Cecilie Kjeldsen; Mdala, Ibrahimu & Atar, Dan (2019). Prehospital assessment of the One-hoUr rule-in/rule-out algorithm using a high-sensitivity cardiac Troponin T assay in a low-prevalence population for Acute Coronary Syndrome (OUT-ACS) (Abstract presentation) . European Heart Journal. ISSN 0195-668X. 40. doi: 10.1093/eurheartj/ehz745.0062.
• Johannessen, Tonje R.; Vallersnes, Odd Martin; Mdala, Ibrahimu; Larstorp, Anne Cecilie Kjeldsen; Atar, Dan & Halvorsen, Sigrun (2019). Prehospital assessment of the One-hoUr rule-in/rule-out algorithm using a high-sensitivity cardiac Troponin T assay in a low-prevalence population for Acute Coronary Syndrome (OUT-ACS study).
• Johannessen, Tonje R.; Vallersnes, Odd Martin; Halvorsen, Sigrun; Larstorp, Anne Cecilie Kjeldsen; Mdala, Ibrahimu & Atar, Dan (2019). OUT-ACS studien: Anvendelse av 0/1-times algoritme for høysensitiv hjertespesifikk Troponin-T for avklaring av NSTEMI på Observasjonsposten ved Legevakten i Oslo.
• Johannessen, Tonje R.; Vallersnes, Odd Martin; Halvorsen, Sigrun; Larstorp, Anne Cecilie Kjeldsen; Mdala, Ibrahimu & Atar, Dan (2019). Prehospital assessment of the One-hoUr rule-in/rule-out algorithm using a high-sensitivity cardiac Troponin T assay in a low-prevalence population for Acute Coronary Syndrome (OUT-ACS) (Abstract presentation) .
• Johannessen, Tonje R.; Vallersnes, Odd Martin; Halvorsen, Sigrun; Larstorp, Anne Cecilie Kjeldsen; Mdala, Ibrahimu & Atar, Dan (2019). Prehospital assessment of the One-hoUr rule-in/rule-out algorithm using a high-sensitivity cardiac Troponin T assay in a low-prevalence population for Acute Coronary Syndrome (OUT-ACS) (Poster og vitenskaplig foredrag) .
• Johannessen, Tonje R. (2018). OUT-ACS-studien: One-hoUr Troponin in a low-prevalence population for Acute Coronary Syndrome.
• Johannessen, Tonje Rambøll (2022). Ruling out acute myocardial infarction in emergency primary care: The OUT-ACS study (One-hoUr Troponin in a low-prevalence population of Acute Coronary Syndrome). Universitetet i Oslo. ISSN 978-82-348-0107-5.

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