Grant: Operating Grant

Doctors use symptoms (eg chest discomfort, and), electrocardiograms, and bloodwork (with Troponins, which are very specific to heart tissue) to diagnose heart attacks. However, bloodwork does have drawbacks, and many patients who are not diagnosed with heart attacks still have elevated troponin levels. These patients are often cared for in hospital areas other than Cardiology. This is a diverse group of patients, including those with a traditional heart attack, but who have other significant health problems (such as a terminal cancer or severe dementia which interfere with standard treatments). Others have a heart attack after an operation. An elevation in troponin can also be due to another stress (such as severe infection, blood clot in the lung, dangerously high or low blood pressure, anemia or trauma). Furthermore, patients with severe kidney disease can have elevated troponins. As a whole, this diverse group of patients has not been well studied, and optimal treatment is not clear. We plan to study all patients with elevated troponin levels who have been admitted to hospital areas other than cardiac wards. We will determine the clinical features, investigations, treatment received, and outcomes of these patients. We want to compare these patients to those with traditional heart attacks who are admitted to cardiology wards. We believe that patients admitted to other services have more medical conditions, and will have less consistency of care in terms of tests and treatments. We plan to identify patients who will benefit from conventional heart attack therapies, and also those patients where these therapies may cause harm, in order to improve the overall care of all patients with elevated troponin levels. These same principles may also be applicable to other medical conditions that are not always treated in specialty areas, such as congestive heart failure, lung disease, and gastrointestinal bleeding.