Developing a brief intervention to communicate cardiovascular risk to patients presenting to the emergency department with chest pain: a co-production approach

Type of funding sources: Foundation. Main funding source(s): Brittish Heart Foundation

The majority of patients who present to the Emergency Department with suspected acute coronary syndrome (ACS) will be discharged once ACS has been ruled out. High-sensitivity cardiac troponin (hs-cTn) is a highly specific biomarker for myocardial injury and is the biomarker of choice for the diagnosis of ACS. However, our previous research on hs-cTn has demonstrated that patients with elevated levels that do not meet the diagnostic threshold for ACS are at increased risk of future cardiac events. These patients are often discharged with no further investigation or understanding of their risk of future cardiac events, despite the potential benefits of preventative strategies.

The aim of this study was to co-design a brief intervention with patients and healthcare professionals to promote cardiovascular health in patients where the diagnoses of ACS has been ruled out but hs-cTn concentrations indicate higher risk of future cardiac events.

Patients who presented to the Emergency Department with symptoms suggestive of ACS and a maximum high-sensitivity troponin between 5 ng/L and the 99th centile were invited to attend a focus group or participate in one-to one interviews. We also interviewed healthcare professionals involved in the care of this group. Patients were recruited using electronic medical records and staff were recruited through social media and posters. Recruitment continued until data saturation was reached. The data was analyzed using thematic analysis. We created protypes based upon the initial data which we presented back to patients and staff for feedback to help refine our brief intervention.

We identified several themes from the data which included; experience of the Emergency Department, previous experience of cardiovascular risk communication, desired information, format of intervention, delivery mode of intervention, timing of delivery, language used and potential barriers. The patients did not have strong preferences on what information should be included in the intervention, however, most patients were receptive to receiving information about their cardiovascular risk guided by hs-cTn. Patients voiced that the intervention should not contain any medical terminology and information should be understood by a lay audience. Many patients and staff felt that the pressures currently faced in the Emergency Department may act as a barrier in delivering the cardiovascular brief intervention.

We have co-produced a cardiovascular brief intervention in collaboration with patients and healthcare professionals. The effect of this brief intervention on cardiovascular outcomes will be tested in a future randomised controlled trial.