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High-sensitivity troponin I-guided cardiovascular risk assessment in a general asymptomatic population: a
Goran Krstačić1,2, Antonija Krstačić2,3, Tin Krstačić4
1Institute for Cardiovascular Prevention and Rehabilitation, Zagreb, Croatia.
Insights
High-sensitivity cardiac troponin I (hs-TnI) screening effectively identifies cardiovascular disease (CVD) risk in asymptomatic adults. This approach reduces CVD events and deaths, proving cost-effective for public health.
Area of Science:
- Cardiology
- Preventive Medicine
- Health Economics
Background:
- Cardiovascular disease (CVD) poses a significant health burden.
- Early risk stratification in asymptomatic adults is crucial for preventive interventions.
- High-sensitivity cardiac troponin I (hs-TnI) shows promise as a biomarker for CVD risk assessment.
Purpose of the Study:
- To evaluate the clinical outcomes and cost-effectiveness of an hs-TnI-guided CVD screening strategy.
- To assess the impact of hs-TnI screening on CVD events, mortality, and resource utilization in a general asymptomatic adult population.
Main Methods:
- A discrete-event microsimulation modeled an observational program involving 4000 asymptomatic adults aged 40-70 years.
- Participants were stratified into low, moderate, and high-risk categories based on hs-TnI levels.
- Outcomes including CVD events, mortality, quality-adjusted life years (QALYs), and costs were estimated over 10 years.
Main Results:
- hs-TnI screening identified 1.5% of participants as high-risk, leading to further cardiac evaluation and intervention.
- Compared to standard care, hs-TnI screening reduced CVD events by 37% and cardiovascular deaths by 34%.
- The strategy gained 16.3 QALYs per 1000 participants with an incremental cost-effectiveness ratio of €32,100/QALY, deemed cost-effective in 93% of simulations.
Conclusions:
- hs-TnI-guided risk assessment effectively stratifies asymptomatic adults and identifies subclinical coronary artery disease (CAD).
- This screening strategy facilitates timely preventive interventions, significantly reducing the burden of CVD.
- The approach demonstrates favorable cost-effectiveness, supporting its implementation in public health initiatives.
Abstract:
High-sensitivity cardiac troponin I (hs-TnI) is a promising biomarker for cardiovascular disease (CVD) risk stratification. This study assessed clinical outcomes and cost-effectiveness of an hs-TnI-guided CVD screening strategy in a general asymptomatic adult population. In a modeled observational program, 4000 adults aged 40-70 years without known CVD underwent hs-TnI testing. Participants were stratified into low (<4 ng/L), moderate (4-10 ng/L), and high (>10 ng/L) risk categories, and underwent further cardiac evaluation, and intervention, if indicated. A discrete-event microsimulation estimated CVD events, mortality, quality-adjusted life years (QALYs), and costs over 10 years. Among 4000 participants (mean age 57.1 ± 8.6 years; 52% women), 3548 (88.7%) were low-risk, 390 (9.8%) moderate-risk, and 62 (1.5%) high-risk. Noninvasive cardiac workup was performed in 452 (11.3%), and coronary angiography in 112 (2.8%). Significant coronary artery disease (CAD) was diagnosed in 49 (1.2%), with revascularization in 45. Compared to standard care, hs-TnI screening reduced CVD events by 37% and cardiovascular deaths by 34%, gaining 16.3 QALYs per 1000 participants. Incremental cost per person was €528, with an incremental cost-effectiveness ratio of €32 100/QALY, remaining cost effective in 93% of simulations. hs-TnI-guided cardiovascular risk assessment effectively stratifies asymptomatic adults, identifies subclinical CAD, and facilitates preventive intervention, appearing cost effective in reducing CVD burden.
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