The Impact of Cardiology Consultation on Medical Intensive Care Unit Patients with Elevated Troponin Levels
Omar Kousa1, Amr Essa1, Mohammed Saleh1
1Department of Internal Medicine, Creighton University, Omaha, Nebraska.
Insights
Cardiology consultation for critically ill patients with elevated cardiac troponin (cTn) did not improve mortality outcomes. While it led to more cardiac testing and longer hospital stays, the impact on patient survival was not significant.
Area of Science:
- Cardiology
- Intensive Care Medicine
- Clinical Outcomes
Background:
- Cardiac troponin (cTn) elevation can occur in critically ill patients due to demand ischemia or myocardial injury, not solely acute coronary syndrome (ACS).
- The clinical impact of cardiology consultation in medical intensive care unit (ICU) patients with elevated cTn is not well-defined.
Purpose of the Study:
- To evaluate the effect of cardiology consultation on clinical outcomes in medical ICU patients with elevated cTn without ACS.
- To identify predictors of cardiology consultation in this patient population.
Main Methods:
- Retrospective analysis of medical ICU patients with elevated cTn (January 2013-December 2018).
- Patients were stratified based on cardiology consultation.
- Primary outcome: 1-year mortality. Secondary outcomes included in-hospital/30-day mortality, length of stay (LOS), cardiac testing, readmission, and new cardiac medications.
Main Results:
- 63.2% of included patients received cardiology consultation.
- Consultation was associated with longer LOS (7 vs. 5 days), increased cardiac testing (90.3% vs. 67.7%), and more new cardiac medications (52.1% vs. 16.3%).
- No significant differences were observed in in-hospital, 30-day, or 1-year mortality, or cardiac readmission rates.
Conclusions:
- Cardiology consultation for elevated cTn in medical ICU patients is linked to increased resource utilization (testing, LOS) without a demonstrable benefit in mortality.
- History of coronary artery disease (CAD) was a significant predictor for cardiology consultation.
Background:
Cardiac troponin (cTn) is mainly used to diagnose acute coronary syndrome (ACS). However, cTn can also be elevated in critically ill patients secondary to demand ischemia or myocardial injury. The impact of cardiology consultation on the clinical outcomes of patients admitted to medical intensive care unit (ICU) with elevated cTn is unclear.
Methods:
A retrospective analysis of medical ICU patients with elevated cTn without evidence of ACS between January 2013 through December 2018. Patients were stratified based on documentation of cardiology consultation. The primary outcome was 1-year mortality. Secondary outcomes were in-hospital and 30-day mortality, the length of stay (LOS), further cardiac testing, 30-day readmission rate, new prescription of cardiac medications, and the predictors of a cardiology consultation.
Results:
Of 846 patients screened, 766 patients were included, of whom 63.2% had cardiology consultation. Cardiology consultation group had longer median LOS (7 vs. 5 days, P = 0.007), additional cardiac testing (90.3% vs. 67.7%, P < 0.001), and more new cardiac medications (52.1% vs. 16.3%, P < 0.001). No difference was noted in-hospital mortality (adjusted odds ratio [aOR], 0.6, 95% CI, 0.4-1.1, P = .117), 30-day mortality (aOR = 0.8, 95% CI, 0.5-1.4, P = .425), 1- year mortality (aOR, 1.4, 95% CI, 0.9-2.2, P = .193), or cardiac-specific 30-day readmission rate (aOR, 7.0, 95% CI, 0.7-14.9, P = .137). History of coronary artery disease (CAD) was the most independent predictor for a cardiology consult (aOR, 2.2, 95% CI, 1.3-3.8, P < .001).
Conclusion:
Cardiology consultation for elevated cTn in medical ICU patients was associated with increased cardiac testing and LOS, without significant impact on mortality.
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