Health Care Resource Utilization for Patients With Suspected Myocardial Infarction: A Secondary Analysis of the...

Area of Science:

• Cardiology
• Emergency Medicine
• Clinical Trials

Background:

• Myocardial infarction (MI) evaluation in emergency departments (EDs) is resource-intensive.
• High-sensitivity cardiac troponin I (hs-cTnI) assays aid in rapid MI rule-out.
• Accelerated hs-cTnI protocols may reduce healthcare resource utilization.

Purpose of the Study:

• To compare a 0-hour and 1-hour (0/1-hour) hs-cTnI protocol with a traditional 0-hour and 3-hour (0/3-hour) protocol.
• To determine if the accelerated protocol reduces health care resource utilization for MI exclusion in the ED.

Main Methods:

• Secondary analysis of the RACE-IT trial, a stepped-wedge randomized clinical implementation trial.
• Involved 32,608 ED patients evaluated for suspected MI across 9 Michigan EDs.
• Compared a 0/1-hour hs-cTnI accelerated protocol against a 0/3-hour standard care protocol.

Main Results:

• The 0/1-hour protocol group showed significantly reduced rates of cardiac stress testing, cardiology consultations, and left heart catheterization.
• Median ED length of stay decreased by 20 minutes in the accelerated protocol group.
• No significant difference in ED discharge to home or cardiac revascularization rates within 30 days was observed.

Conclusions:

• The 0/1-hour hs-cTnI protocol effectively reduces cardiac evaluations and ED length of stay for MI exclusion.
• This accelerated approach optimizes healthcare resource utilization in EDs.
• The findings suggest this protocol can be safely implemented without increasing revascularization rates.