Due to copyright issues, an electronic copy of the thesis must be ordered from the faculty. For the faculty to have time to process the order, the order must be received by the faculty at the latest 2 days before the public defence. Orders received later than 2 days before the defence will not be processed. After the public defence, please address any inquiries regarding the thesis to the candidate.
Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Professor Nicholas L. Mills, University of Edinburgh and Royal Infirmary of Edinburgh, UK
- Second opponent: Professor Guri Rørtveit, University of Bergen
- Third member and chair of the evaluation committee: Associate Professor Olav Klingenberg, University of Oslo
Chair of the Defence
Professor Torbjørn Omland, University of Oslo
Principal Supervisor
Associate Professor, Odd Martin Vallersnes, University of Oslo
Summary
Chest pain is a frequent presenting symptom in emergency primary care, challenging due to the lack of sensitive diagnostic tools to exclude an acute myocardial infarction (AMI). The consequent clinical uncertainty contributes to high hospital referral rates of low-risk patients, congested emergency departments, and extensive use of healthcare resources and procedures of limited added value.
The observational OUT-ACS (One-hoUr Troponin in a low-prevalence population of Acute Coronary Syndrome) study was conducted from 2016 to 2018 at a large emergency primary care clinic in Oslo, Norway. The aim was to investigate whether AMI could be excluded in low-risk patients using a 0/1-hour algorithm for high-sensitivity cardiac troponin T (hs-cTnT). AMI was adjudicated in 61 (3.6%) of 1711 patients. The patients were categorised as rule-out, rule-in or further observation by the algorithm, following the European Society of Cardiology guidelines.
For patients assigned to the large AMI rule-out group (76.6 %), the algorithm achieved high safety at the index episode and had few events in the following 90 days. A total of 4% was assigned towards rule-in with a moderate AMI accuracy. The overall efficacy and safety of the algorithm were further improved by applying novel criteria for patients in the observation group.
We also found that the rule-out performance of a single troponin measurement was superior to the HEART (History, ECG, Age, Risk factors and Troponin) score in our low-risk cohort. Finally, assessing low-risk patients with chest pain in emergency primary care was shown to be cost-effective, with €1794 saved per low-risk patient and a mean decrease in length of stay of 18.9 hours compared to routine hospital management.
Based on our findings, the 0/1-hour algorithm appears safe, efficient, and cost-effective for assessing low-risk patients with chest pain in emergency primary care.
Additional information
Contact the research support staff.