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Diagnosis of cardiac conditions in primary care

Traditionally, diagnosis of cardiac conditions such as heart failure, deep vein thrombosis, venous thromboembolism, acute coronary syndrome, and coronary heart disease has taken place in hospitals and tests carried out in the laboratory …


However, the increasing focus of the NHS on patient-centred care, coupled with significant advances in point-of-care (POC) technologies, have allowed primary care to deliver cardiac diagnoses, providing patients with a more convenient and flexible service, and healthcare professionals with instant access to lifesaving diagnostic results.

An increased role for primary care is supported by the National Service Framework for CHD, which states: "Practices should put in place models of care so that they use a systematic approach … for identifying people at high risk of CHD … [and] offering regular review to people at high risk of CHD."

POC testing in primary care can deliver reliable, on-the-spot results, critical in allowing the GP to make vital treatment decisions to improve patient outcomes. POC testing also means that unnecessary hospital referrals are avoided and specialist care is freed up for those who really need it, which will help the NHS to reach its waiting time targets for 2008.

As the emphasis continues to shift towards moving services into the community and reducing pressure on secondary care, POC testing to identify cardiac conditions is a key area for further development, offering clinical, practical and financial benefits.

The NICE guidance for chronic heart failure - Management of Chronic Heart Failure in Adults in P and in Secondary Care (reviewed 2007) - suggests an algorithm for the diagnosis of heart failure, which includes the use of diagnostic assessment, as shown in Box 1.


The cobas h 232 system: improving the diagnosis of cardiac conditions

The cobas h 232 system from Roche Diagnostics is a new handheld system for on-the-spot cardiovascular diagnoses. The system incorporates five key cardiac markers: NTproBNP, troponin T, CK-MB, myoglobin and D-dimer

This range of markers allows the rapid and accurate diagnosis of cardiovascular conditions such as ACS and heart failure and also of thromboembolic events in either primary or secondary care.

Comparative studies have demonstrated a good level of correlation with laboratory tests.

The cobas h 232 system is easy and convenient to use, delivering results in eight to 12 minutes. It is maintenance-free and has internal and external quality control and assurance to ensure results are reliable and accurate. The system also includes a lock-out function, ensuring it can only be used by authorised personnel.

Quality control and data management features can be tailored to requirements. The cobas h 232 system is compatible with the cobas IT 1000 data management solution, which can collect and analyse tests results and store them electronically in a central patient record to further improve the efficiency of the diagnostic service. For enquiries about the cobas h 232 system please contact Roche Diagnostics on: 0144 4256000 or by email at: Find out more at