Diagnostic patterns and stress testing trends after implementing high-sensitivity troponin assay

Area of Science:

• Cardiology
• Clinical Diagnostics
• Health Services Research

Background:

• High-sensitivity troponin T (hsTnT) testing is a newer diagnostic tool approved in the US for acute coronary syndrome (ACS).
• While international studies exist, the impact of hsTnT on US-based discharge diagnoses and healthcare utilization remains less understood.
• Understanding these impacts is crucial for healthcare providers and policymakers.

Purpose of the Study:

• To evaluate the effects of implementing hsTnT testing on diagnosis patterns for suspected ACS.
• To assess the impact of hsTnT implementation on stress testing utilization.
• To provide insights into potential long-term healthcare utilization and cost implications.

Main Methods:

• A retrospective cohort analysis comparing patients who underwent conventional troponin I testing versus hsTnT testing.
• Data collected from January 2016 to February 2019, encompassing 14,631 patients with troponin I and 7,237 with hsTnT.
• Statistical modeling using log-binomial regression with interrupted time series for diagnoses and logistic regression for stress testing rates.

Main Results:

• No significant change was observed in acute myocardial infarction-related discharge diagnoses post-hsTnT implementation (AME: -0.6%, P=0.065).
• A significant increase in heart failure (2.1%, P<.001) and atrial fibrillation/flutter (0.9%, P<.001) diagnoses was noted.
• A decrease in hypertensive heart disease diagnoses was observed (-10.2%, P<.01), alongside increased stress testing utilization (2.3%, P<.001).

Conclusions:

• Implementation of hsTnT testing in the US is associated with shifts in discharge diagnosis patterns.
• Increased utilization of stress testing was observed following hsTnT adoption.
• These changes may have significant long-term implications for healthcare utilization, costs, and hospital reimbursement models.