For Martin Black, it feels exactly like a heart attack.
"A pressure, an uncomfortable feeling," says the 89-year-old Black, who lives in Sarasota, Fla.
The pain starts on his left side just below his heart. Sometimes it goes away, but sometimes it lasts for hours. While the pain first only came at night, it has also pestered him in the early evening or early morning.
Out of concern for his health, Black did what anyone else would do. "I would call my doctor's service," he says. "Sometimes they would say, 'Call 911 and go to the hospital.'"
So he would.
As a result, Black has gone to the emergency room about 10 times for chest pain in the past few years. Such unexpected visits have led to his missing family parties and graduations, not to mention the large medical bills.
Black has few complaints, of course. He knows what doctors do, that such visits are crucial when it comes to ruling out a life-threatening situation. But, he said, the long wait for test results is more than just simply inconvenient for him.
"I'm not interested in staying [in the hospital] overnight," Martin said. "It's expensive; I've seen some of the Medicare bills that come out after I spend a night. ... The emergency room beds are not very comfortable, and it's not very pleasant to have to spend the night there getting blood tests."
New research suggests, however, that unnecessary hospital admissions under these circumstances might soon be a thing of the past.
A study released today in the journal Archives of Internal Medicine suggests that a new, more sensitive test for substances known as troponins, which are released by heart tissue during a heart attack, could help doctors determine whether a patient is having a heart attack within one hour.
Doctors now use troponins to monitor how much damage is occurring in the heart. Troponin levels are checked in patients who might be having heart attacks, on admission and at subsequent time intervals in the next eight to twelve hours. Potentially, the patient's first troponin test could be negative, but a subsequent test could show it as positive. So many patients must stay in the hospital for long periods of time, placing both a strain on patients as well as over-crowed emergency department and hospitals.
The new method described by Swiss researchers appears to be able to distinguish between a heart attack and chest pain from other causes after only 60 minutes for 77 percent of patients. The method involves taking blood when a patient first gets to the hospital and then repeating the test one hour later. The initial value of the high-sensitivity troponin test, as well as the change, along with information doctors gather from the electrocardiogram, history and physical exam, can point to whether a heart attack is actually in progress.
More than 5 million people come to the emergency department every year with chest pain at a cost of more than $6 billion to the health care system but only about 1.6 million, or 32 percent, are actually having a heart attack. So such a test, if it became a clinical reality, could represent huge savings in costs and time if implemented.
Cardiologists, however, cautioned that the test is not yet ready for widespread use, at least until all of the potential problems can be ironed out.
Dr. Christopher Cannon of the Cardiovascular Division of Brigham and Women's Hospital in Boston says that the tool sounds promising, but adds that the methods for using the information provided by a more sensitive test for troponin need to be tested and proven before they become a standard approach.
"It would help on the efficiency," Cannon says. "But this rule needs to be validated and refined."
There are also several heart conditions that can be dangerous but are not a heart attack that should be looked for in the emergency department.
Dr. Clyde Yancy, chief of cardiology at Northwestern University in Chicago, says that while a new tool to distinguish one case of chest pain from another would be helpful, "We should maintain an approach that incorporates useful tools in our diagnostic armamentarium but not allow this or any other diagnostic tool to trump the needed clinical judgment in the patient that is acutely ill."