Grant: Project Grant

Women with heart disease are under-diagnosed, under-treated, and have worse outcomes than men. Among young women (<55 years) with a heart attack, the risk of death is 2X higher than among men of the same age. With the introduction of a more sensitive diagnostic test - high sensitivity cardiac troponin (hs-cTn), it has become apparent that using a single level (cut-point) to identify patients with a heart attack disadvantages women. Hs-cTn is a biomarker, or protein, released into the blood when the heart is damaged during heart attack. Women produce lower amounts of this biomarker when they have a heart attack than men. We believe that by using a lower cut-point for hs-cTn in women, we will identify more women who have had damage to their hearts, and this will allow us to provide better care, leading to better outcomes for these women. The study will be conducted in 26 emergency departments (EDs) across Canada. Every site will start using the standard single cut-point to identify patients with heart attack or heart damage. Randomly, they will be asked to change practice in their hospitals by using a lower cut-point for women; the cut-point for men will remain unchanged. At the end of the study, every ED will be using the lower cut-point in women. We will then determine what impact this change has had on additional diagnostic testing, like referral to cardiology for an x-ray of the heart, stress testing, etc. We will also determine if there has been a change in outcomes as a result of this change. Specifically, we will determine if, after the introduction of a lower cut-point, women are more likely to received appropriate care and are less likely to die, present to hospital with a heart attack, stroke, heart failure, or the need for urgent revascularization (procedures to open clogged arteries) within a year of discharge from the hospital. We believe this simple change in health care delivery will improve the care and outcomes of women with suspected heart disease.