Emergency cardiac biomarkers and point-of-care testing: Optimizing acute coronary syndrome care using small-world networks in rural settings

Gerald J Kost, Laurie E. Kost, Audhaiwan Suwanyangyuen, Simrin K. Cheema, Corbin Curtis, Stephanie Sumner, Jimmy Yu, Richard F. Louie

Research output: Contribution to journalArticlepeer-review

15 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)53-64
Number of pages12
JournalPoint of Care
Issue number2
StatePublished - Jun 2010


  • Ambulance
  • Anamai
  • Cardiac troponin (cTnI, cTnT)
  • Community hospital (CH)
  • Heart center
  • Isaan
  • Mekong river
  • O saturation
  • Primary care unit (PCU)
  • Pro-brain natriuretic peptide (proBNP)
  • Regional hospital (RH)
  • Thailand
  • Therapeutic turnaround time (TTAT)

ASJC Scopus subject areas

  • Nursing(all)


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