College of Medicine & Veterinary Medicine

Heart test changes could save lives

New advice for doctors could prevent almost 3000 heart attacks being missed each year, Edinburgh researchers say.

They have called for the guidelines on using blood tests to diagnose heart attacks to be urgently implemented to help save lives.

Blood test

The blood test works by detecting a molecule called troponin, which is found in the blood following a heart attack.

People suspected of having a heart attack are given the troponin test when they arrive in Accident and Emergency, and again after three hours.


If levels of troponin in the blood are below that needed to diagnose a heart attack, doctors will look for another cause.

The researchers say that not all heart attack patients will have a significantly raised troponin level three hours after presenting at A&E, however.

Small changes

By identifying very small changes in troponin levels at three hours – compared with those taken on arrival – they were able to more confidently predict if a person had suffered a heart attack.

The team studied 1,218 people who presented at A&E complaining of chest pains between June 2013 and September 2015.

New guidelines

When doctors used the troponin test under current clinical guidelines, the researchers found that 18 heart attacks were missed, equating to one in every 50 heart attacks. With the new guidelines, only two heart attacks were missed.

Given heart attacks are the single leading cause of death in the UK, we believe our findings will improve care for patients, and give clinicians increased confidence in the use of newer diagnostic tests.

Dr Andrew ChapmanBHF Clinical Research Fellow, University of Edinburgh


With around 188,000 heart attacks taking place in the UK each year, experts say the new protocol could prevent almost 3,000 heart attacks from being missed.

The new guidelines were also able to immediately rule out heart attacks in more patients.

Heart disease

Heart disease is the UK’s single biggest killer accounting for nearly 70,000 deaths in the UK each year.

Clinical guidelines should be changed as a result of this clinical trial. We want to ensure that no heart attack diagnosis is missed so patients aren’t sent home when they are at risk and need to be treated.

Professor Sir Nilesh SamaniMedical Director, British Heart Foundation


The researchers have now developed an app to help clinicians to implement the guidelines in practice.

The study, published in Circulation, was funded by the British Heart Foundation.

Related links

Journal article

BHF Centre for Cardiovascular Science

Edinburgh Medical School