Implementation of a High-Sensitivity Troponin Assay and Its Association With Resource Utilization in Patients With
Radhika K Neicheril1, Yosef Manla1, Daniel Chacon2
1Department of Cardiology, Section of Heart Failure & Cardiac Transplant Medicine, Cleveland Clinic Florida, Weston, FL.
Insights
Implementing high-sensitivity cardiac troponin (hs-cTn) assays in the emergency department (ED) significantly reduces downstream testing and resource use for acute coronary syndrome (ACS) patients. This optimization of care presents an opportunity for wider hs-cTn adoption.
Area of Science:
- Cardiology
- Emergency Medicine
- Biomarker Assays
Background:
- Acute coronary syndrome (ACS) diagnosis relies on cardiac troponin levels.
- Conventional cardiac troponin (c-cTn) assays may lack sensitivity, leading to increased resource utilization.
- High-sensitivity cardiac troponin (hs-cTn) assays offer improved sensitivity for early ACS detection.
Purpose of the Study:
- To evaluate the impact of implementing hs-cTn assays in the emergency department (ED).
- To assess the association between hs-cTn use and downstream resource utilization in patients with suspected ACS.
- To compare resource utilization between hs-cTn and conventional c-cTn assays.
Main Methods:
- Retrospective analysis of 461 ED encounters for suspected ACS.
- Propensity score-matched analysis comparing 150 encounters using c-cTn with 150 using hs-cTn.
- Comparison of downstream resource utilization: cardiology consults, cardiovascular imaging, disposition, ED length of stay, and 30-day outcomes.
Main Results:
- The hs-cTn group showed significantly lower rates of cardiology consults (4% vs 30%), echocardiograms (6.7% vs 39.3%), nuclear stress tests (4% vs 18%), and cardiac catheterization (1.3% vs 18%).
- Fewer patients in the hs-cTn group were referred to observation (11.3% vs 64%) or admitted (4.7% vs 28%).
- Median ED length of stay was significantly shorter with hs-cTn (4 hours vs 28 hours), with comparable 30-day ACS readmission and mortality rates.
Conclusions:
- Implementation of hs-cTn assays in the ED significantly reduces downstream testing and hospital resource utilization for suspected ACS.
- Wider adoption of hs-cTn assays can optimize the care pathway for patients with suspected ACS.
- hs-cTn assays facilitate efficient resource allocation without compromising patient safety outcomes.
Objective:
To examine the association between the implementation of high-sensitivity cardiac troponin (hs-cTn) and downstream resource utilization in patients presenting to the emergency department (ED) with suspected acute coronary syndrome (ACS).
Patients And Methods:
We analyzed 461 ED encounters of patients with suspected ACS between January 1, 2022 and December 12, 2022. The final propensity score-matched analysis included 300 encounters in which the conventional cardiac troponin (c-cTn) assay (n=150) or hs-cTn assay (n=150) was used. Groups were compared for downstream resource utilization, including cardiology consults, cardiovascular imaging, disposition of care, ED length of stay, and 30-day outcomes, using appropriate statistical testing.
Results:
Compared with the c-cTn group, the hs-cTn group had a lower rate of requiring cardiology consults (6 [4%] vs 45 [30%]; P<.001) and reduced downstream utilization of echocardiograms (10 [6.7%] vs 59 [39.3%]; P<.001), nuclear stress tests (6 [4%] vs 27 [18%] P<.001), and cardiac catheterization (2 [1.3%] vs 27 [18%]; P<.001). Significantly fewer patients were referred to observation (17 [11.3%] vs 96 [64%]; P<.001) or admitted (7 [4.7%] vs 42 [28%]; P<.001) in the hs-cTn assay group. In addition, the median ED length of stay was significantly shorter in the hs-cTn group (4 vs 28 hours; P<.001). The 30-day outcomes, including readmission for ACS (0 [0%] vs 0 [0%]; P>.99) or mortality (0 [0%] vs 1 [0.7%]; P>.99) rates, were comparable.
Conclusion:
Implementing hs-cTn in the ED can significantly reduce downstream testing and hospital resource utilization. Wider adoption of hs-cTn assays could present an opportunity to optimize care of patients with suspected ACS.
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