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Emergency Cardiac Biomarkers and Point-of-Care Testing: Optimizing Acute Coronary Syndrome Care Using Small-World Networks in Rural Settings

Kost, Gerald J. MD, PhD, MS, FACB*†; Kost, Laurie E. MS; Suwanyangyuen, Audhaiwan MBA; Cheema, Simrin K. BS*; Curtis, Corbin BS*; Sumner, Stephanie*; Yu, Jimmy BS*; Louie, Richard F. PhD*

doi: 10.1097/POC.0b013e3181d9d45c
Original Articles

Objectives: To improve the speed of efficient diagnosis of acute chest pain in patients in rural emergency departments of low-resource community hospitals (CHs), to optimize point-of-care cardiac biomarker testing, and to carefully align referral and treatment within strategic care paths.

Methods and Setting: Near the Mekong River in northern Isaan, Thai provinces with unique geographic patterns of health care delivery form interactive small-world networks (SWNs). We conducted on-site surveys in the Thai language at 10 CHs and 5 regional hospitals, with consideration of linked primary care units in villages. We also surveyed 3 referral centers in Khon Kaen City.

Results: Small-world network distances (kilometers) and travel time (hours) between primary care units and CHs were modest. However, challenging terrain makes it difficult for ambulances to transport patients between CHs and regional hospitals or to the more distant Queen Sirikit Heart Center. Therefore, early point-of-care diagnosis of acute myocardial infarction in emergency departments is needed throughout Isaan. Laboratory technologists, nurses, and physicians rated (lower to higher) the benefits of rapid-response cardiac troponin testing differently. Still, few sites provided this testing directly at the point of physician need.

Conclusions: Point-of-care cardiac biomarker testing is warranted in rural SWNs to guide early therapy. Cardiologists are needed to deliver interventional therapy. Handheld and small benchtop instruments can be implemented effectively in SWNs not just for faster rescue, transport, and treatment of critically ill patients with acute myocardial infarction but also for improved medical and economic outcomes that physicians and public health officials value highly.

From the *Point-of-Care Testing Center for Teaching and Research (POCT·CTR) and the UC Davis- LLNL Point-of-Care Technologies Center (NIBIB, NIH), Department of Pathology and Laboratory Medicine, School ofMedicine, University of California, Davis, CA; †College of Population Studies, Chulalongkorn University, Bangkok, Thailand; and ‡Hopkins Marine Station, Stanford University, Pacific Grove, CA.

Reprints: Gerald J. Kost, MD, PhD, MS, FACB, POC Technologies Center (NIBIB, NIH) and POCT·CTR, Department of Pathology and Laboratory Medicine, School of Medicine, 3455 Tupper Hall, University of California, Davis, CA 95616. E-mail:

This research was supported in part by the Edward W. and Ora I. Kost Foundation; the Point-of-Care Testing Center for Teaching and Research, School of Medicine, University of California, Davis; and a National Institute of Biomedical Imaging and Bioengineering Point-of-Care Technologies Center grant (Dr Kost, Principal Investigator, National Institutes of Health U54 EB007959).

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Biomedical Imaging and Bioengineering or the National Institutes of Health.

© 2010 Lippincott Williams & Wilkins, Inc.