Interhospital variation in the RATPAC Trial (Randomised Assessment of Treatment using Panel Assay of Cardiac markers)
- Mike Bradburn1,
- Steve W Goodacre1,
- Patrick Fitzgerald1,
- Tim Coats2,
- Alasdair Gray3,
- Taj Hassan4,
- Julian Humphrey5,
- Jason Kendall6,
- Jason Smith7,
- Paul Collinson8,
- On behalf of the RATPAC Research Team*
- 1School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
- 2Emergency Department, Leicester Royal Infirmary, Leicester, UK
- 3Emergency Department, Royal Infirmary of Edinburgh, Edinburgh, UK
- 4Emergency Department, Leeds General Infirmary, Leeds, UK
- 5Emergency Department, Barnsley District General Hospital, Barnsley, UK
- 6Emergency Department, Frenchay Hospital, Bristol, UK
- 7Emergency Department, Derriford Hospital, Plymouth, UK
- 8Department of Chemical Pathology, St Georges Hospital, London, UK
- Correspondence to Steve Goodacre, University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK;
Contributors The article was written on behalf of the RATPAC Research Team. Mike Bradburn and Patrick Fitzgerald analysed and interpreted the data, contributed to re-drafting of the paper and approved the final version. Steve Goodacre was Chief Investigator, wrote the first draft of the paper and approved the final version. Tim Coats, Alasdair Gray, Taj Hassan, Julian Humphrey, Jason Kendall and Jason Smith were Principal Investigators in the participating centres, contributed to re-drafting of the paper and approved the final version. Paul Collinson provided specialist input to the biomarker component, redrafting the paper and approved the final version. Steve Goodacre is guarantor for the paper.
- Accepted 22 February 2011
- Published Online First 26 May 2011
Background The RATPAC trial showed that using a point-of-care panel of CK-MB(mass), myoglobin and troponin at baseline and 90 min increased the proportion of patients successfully discharged home, leading to reduced median length of initial hospital stay. However, it did not change mean hospital stay and may have increased mean costs per patient. The aim of this study was to explore variation in outcome and costs between participating hospitals.
Methods RATPAC was a pragmatic multicentre randomised controlled trial (N=2243) and economic analysis comparing diagnostic assessment using the panel to standard care for patients with acute chest pain due to suspected myocardial infarction at six hospitals. The difference in the proportion of patients successfully discharged (primary outcome) and mean costs per patient between the participating hospitals was compared.
Results Point-of-care assessment led to a higher proportion of successful discharges in four hospitals, a lower proportion in one and was equivocal in another. The OR (95% CI) for the primary outcome varied from 0.12 (0.01 to 1.03) to 11.07 (6.23 to 19.66) with significant heterogeneity between the centres (p<0.001). The mean cost per patient for the intervention group ranged from being £214.49 less than the control group (−132.56 to 657.10) to £646.57 more expensive (73.12 to 1612.71), with weak evidence of heterogeneity between the centres (p=0.0803).
Conclusion The effect of point-of-care panel assessment on successful discharge and costs per patient varied markedly between hospitals and may depend on local protocols, staff practices and available facilities.
- Myocardial infarction
- randomised trial
- cardiac markers
- cardiac care
- acute myocardial infract
Disclaimer The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the NIHR HTA.
↵* The RATPAC Research Team, Trial Steering Committee and Data Monitoring Committee are listed in appendix 1.
Funding National Institute for Health Research, Health Technology Assessment Programme
Competing interest None.
Ethics approval This study was conducted with the approval of the Leeds East REC.
Provenance and peer review Not commissioned; externally peer reviewed.