Welcome to the RATPAC study website

RATPAC [ISRCTN37823923]


Randomised Assessment of Treatment using Panel Assay of Cardiac markers

The Challenges

During the early 2000s chest pain was responsible for around 700,000 emergency department (ED) attendances and around one-quarter of hospital admissions each year in England and Wales. Of these, only a minority (5-10%) were due to acute myocardial infarction but these need to be rapidly and accurately identified. Current recommendations at the time included 12-lead ECG, chest radiograph and a 12-hour troponin test. The latter usually required hospitalisation which for the majority of cases was unnecessary.
A rapid point of care (PoC) test had been developed which offered the potential to diagnose and safely discharge patients without AMI. There was however no large scale evaluation of whether this led to improved decision making, patient outcomes or reduced health care costs.

The Research

The trial was a large scale, pragmatic randomised controlled trial of patients attending ED with acute chest pain due to suspected acute myocardial infarction. The trial was undertaken in six centres and had a planned sample size of 3130. Outcomes were 4-hour admission and re-admission, major cardiac events and adverse events, length of stay, quality of life and satisfaction with care. A cost-effectiveness analysis was undertaken alongside. In addition, blood samples were taken from study participants and were subsequently analysed as part of a follow-up HTA grant to evaluate alternative PoC decision rules :RATPAC- CBE ( contemporary biomarker evaluation).

The Results

The trial recruited 2263 participants. 358 of the 1125 (32%) participants randomised to PoC were successfully discharged compared with 146/1118 (13%) in the standard care group. Although the median length of stay was reduced (8.8 hours versus 14.2 hours) the mean inpatient days were similar (1.8 vs 1.7 days). There were also considerable differences between the six centres. The subsequent biomarker analyses demonstrated that additional markers did not improve on the diagnostic accuracy of troponin on its own.

The Impact

RATPAC showed that point-of-care panel testing didn't work and as a result it hasn’t been widely adopted. It’s impact was to prevent adoption of an ineffective (or non cost-effective) technology.

The RATPAC CBE trial has resulted in several impact publications and results have been included in IPD meta-analysis (one has just been accepted by Annals of Internal Medicine). The findings have had an important impact, providing evidence to support the use of high sensitivity troponin in ruling out heart attack without hospital admission.

Publications

To access the HTA report, please click 'HTA monograph RATPAC May2011' in the right hand column of this page.

To access the online articles, please click on the links below:

RATPAC economic analysis published in Acad Emer Med, 2011

RATPAC paper published in EMJ, 2011

Health Technology Assessment Monograph, 2011

RATPAC main analysis published in Heart, 2010

Study Staff

Liz Cross
Trial Manager
0114 222 0762

email : e.a.cross@sheffield.ac.uk

Steve Goodacre
Principal Investigator
0114 222 0842

email : s.goodacre@sheffield.ac.uk

Susan Proctor
RATPAC Clerical Assistant
0114 222 0769

email : s.b.proctor@sheffield.ac.uk

Health Services Research
School of Health & Related Research
Regent Court, 30 Regent Street
SHEFFIELD
S1 4DA
United Kingdom

ISRCTN378239293