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How can new diagnostic methods contribute in healthcare? What are doctors looking for?
•Better support in their clinical decision makings, which includes:
omore accurate diagnosisoreliable prognostic estimationotools for therapy stratification and monitoring
•Rapid answers to the patient in order to:
oreduce the need for later reevaluation of the patientoprovide the patient with maximal information at the doctor´s visit
How can new diagnostic methods contribute in healthcare? What are doctors looking for?
1. More accurate diagnostic and prognostic markers in cardio-vascular disease
2. Markers for the distinction between bacterial and viral causes of acute infections
3. And more
Heart disease accounts for 49% of all deaths in Europe
The estimated cost for the society in Europe is 169 billion euros
Cardiac troponins in a healthy population –the impact of an ultra-sensitive troponin assay
35 40 45 50 55 60 65 70 75 80
Age
0,00
0,01
0,02
0,03
0,04
0,05
0,06
0,07
0,08
cTn
I, A
ccu
Tn
I g
/L
99th percentile URL
99th percentile <60 y
ULSAM-studyUppsala Longitudinal Study of Adult Men
• All men in Uppsala born between 1920 and 1924All 50 years old men (n=2841) were invited for the investigation, 81.7% (n=2322) participated
• Remaining cohort at 70 years of age n =1673 (73%
participated n=1221)– Men without cardiovascular disease disease n = 853
– Men with cardiovascular disease n = 368
• Follow-up period 10.4 years
Outcome (Death) in 70 years old men, with or without CVD, in relation to cTroponin I (AccuTnI)
cTroponin I, g/L
>0.039 >0.02-<0.04 <0.021 >0.039 >0.02-<0.04 <0.021
Out
com
e. d
eath
%
0
20
40
60
80
Healthy Diseased
p<0.0001
p<0.0001
p=0.002
p=0.03
Thus, the development and use of ultra-sensitive troponin assays
as indicators of myocardial dysfunction and leakage
will enable us to identify many more subjects
at risk of premature death in cardio-vascular disease
Heart failure – a deadly disease and a diagnostic dilemma
Correct diagnosis – correct treatment False diagnosis – wrong treatment
Missed diagnosis – no treatment
Heart failure – the impact of assaying blood levels of natriuretic peptides (BNP and NT-proBNP)
Correct diagnosis – correct treatment False diagnosis – wrong treatment
Missed diagnosis – no treatment
NT-proBNP in healthy 70-year old men in relation to all-cause death during a 10 year follow-up, n=839 (ULSAM)
05
101520
2530
354045
<100 100 200 300 400 500 >600
NT-proBNP, ng/L
% D
eath
Should my patient be prescribed antibiotics or not?
49% of all patients visiting a primary health care unit in Sweden called the doctor because of symptoms of acute infection
The clinical diagnosis of most respiratory infections such as pneumonia, pharyngitis/tonsillitis, otitis has, when based on symptoms and physical signs only,
a diagnostic sensitivity and specificity of 55-60% in the distinction between a viral or bacterial cause of the infection
P-CRP and B-PMN in acute infections
Bacteria Virus Virus Bacteria
0
250
500
750
0
2
4
6
8
10
12
14
16
18
20
CRP PMN
mg
/Lx10
9/L
P-CRP
S-HNL
0 20 40 60 80 100
100
80
60
40
20
0
100-Specificity
Sens
itivi
ty
Discrimination between acute bacterial and viral infectionsHospitalized adult population
Highest diagnosti
c accu
racy in le
ft corner
Internists base their clinical management to 70-80% on laboratory tests
Primary care doctors base their clinical management to 10-20% on laboratory tests
Laboratory testing is an efficient means to save money in health caresince it provides the doctor with:
Some conclusions
more accurate diagnosismore reliable prognostic estimationbetter tools for therapy stratification and monitoring
All for the benefit of our patients and the society