Chest pain management: use of troponins in internal medicine wards

To probe the reference biomarkers used to manage chest pain (CP) by Italian internists.

Two hundred and fifty-seven doctors registered as members of the Federation of Associations of Hospital Doctors on Internal Medicine of the Campania Region (FADOI-Campania) were surveyed by means of Google Forms platform. Each participant was asked to report his/her sex, age, and location and hospital size (beds in hospital) in which he/she worked. Furthermore, they were asked to indicate the reference biomarker he/she usually employed in the management of patients with CP, choosing from four possible answers. In line with national and international guidelines, cardiac troponins are the gold standard biomarkers.

Eighty-two internists (30 females) completed the survey. Interestingly, only 30.5% of participants indicated the cardiac troponins as reference biomarker. Moreover, internists working in medium-sized hospitals appeared to prefer the simultaneous measurement of cardiac troponins and Creatine Kinase MB Isoenzyme.

Given the economic impact of performing inappropriate examinations and the frequency of the CP symptom and associated diseases, rethinking pathways in a multidisciplinary and shared fashion can promote optimization and appropriateness, and therefore stop wastefulness.