Related Experiment Video
Updated: Mar 12, 2026
Signal Acquisition, Score Interpretation, and Economics of a Non-Invasive Point-of-Care Test for Coronary Artery Disease
Published on: August 9, 2024
Financial impact of a targeted reduction in cardiac enzyme testing at a community hospital
Li Zhang1, Anne M Sill1, Ilene Young2
1St Agnes Hospital, Baltimore, MD, USA.
Insights
Removing unnecessary cardiac enzyme tests like CK-MB and myoglobin from acute coronary syndrome (ACS) workups significantly reduced laboratory testing and saved healthcare payers over $463,000 annually.
Area of Science:
- Clinical Chemistry
- Healthcare Economics
- Laboratory Medicine
Background:
- Unnecessary laboratory testing contributes significantly to avoidable healthcare expenditures.
- Cardiac enzyme testing is a common component of acute coronary syndrome (ACS) workups.
- Optimizing laboratory test utilization is crucial for cost containment in healthcare.
Purpose of the Study:
- To evaluate the financial impact of reducing the use of creatinine kinase (CK)-MB and myoglobin tests.
- To assess the effect of removing specific cardiac enzyme tests from routine ACS order sets at a community hospital.
Main Methods:
- A hospital-wide intervention de-emphasized the use of CK, CK-MB, myoglobin, SGOT, and SGPT for ACS evaluation.
- These tests were removed from pre-checked computerized order sets, requiring individual ordering.
- Monthly test volumes and cost savings were compared before and after the intervention.
Main Results:
- A dramatic decrease in the utilization of CK, CK-MB, myoglobin, SGOT, and SGPT tests for ACS workup was observed (p<0.001).
- Troponin testing volumes remained unchanged (p=0.283).
- Total annual cost savings to healthcare payers amounted to $463,744.7.
Conclusions:
- Removing specific cardiac enzyme tests (CK-MB, myoglobin, CK, SGOT, SGPT) from order sets effectively reduces unnecessary laboratory testing in ACS evaluations.
- This intervention leads to substantial cost savings for the healthcare system.
Objectives:
Nearly one-third of healthcare costs are potentially avoidable and would not compromise medical care if eliminated. Therefore, we sought to evaluate the financial impact of reduction in use of creatinine kinase (CK)-MB and myoglobin tests after removing them from the cardiac enzyme order set at a community hospital.
Methods:
Grand rounds were held, and an email notification was sent to de-emphasize the use of CK, CK-MB, myoglobin, SGOT (glutamic-oxaloacetic transaminase), and SGPT (serum glutamic-pyruvic transaminase) in acute coronary syndrome (ACS) work up. The above tests were removed from the pre-checked cardiac enzyme order set in the computerized physician order entry on February 13, 2014. The tests continued to be available, but needed to be ordered individually. The mean monthly volume of cardiac enzyme tests for 12 months after this intervention was compared with the mean monthly volume of 12 months before the change. Total cost savings were calculated.
Results:
After the intervention, the number of CK, CK-MB, myoglobin, SGOT, and SGPT tests utilized for ACS workup decreased dramatically (p<0.001). The volume of troponin testing remained the same (p=0.283). The total annual savings of billable charges to healthcare payers was $463,744.7.
Conclusions:
Removal of CK-MB, myoglobin, CK, SGOT, and SGPT tests from cardiac enzyme order sets can successfully reduce unnecessary laboratory testing for ACS workup, leading to significant cost savings to the healthcare system.
Related Concept Videos
01:20Blood Studies for Cardiovascular System I: Cardiac Biomarkers
The essential diagnostic tools for detecting myocardial necrosis and monitoring individuals suspected of having acute coronary syndrome (ACS) include:
Troponins
Troponins, particularly cardiac troponins I and T, are the most precise and sensitive markers of myocardial injury. They are detectable within 4-6 hours of myocardial injury and remain...
01:19Blood Studies for Cardiovascular System II: CRP, Hcy, and Cardiac Natriuretic Peptide Markers
These markers indicate stress or strain on the heart muscle:
Natriuretic Peptides (BNP)
Cardiac myocytes produce these hormones in response to ventricular stretching...
01:29Cardiomyopathy III: Hypertrophic Cardiomyopathy
01:28Cardiac Catheterization I: Pre-Procedure Overview
01:25Errors occurring during blood pressure monitoring
Several factors...