Cardiovascular
Clinical Consequences Post-Implementation of a 5th Generation Cardiac Troponin Assay at an Academic Medical Center in Western Pennsylvania Brent Willaims* Teigan Dwyer Tyson Barrett Amber Shergill Indu Poornima
Background: High-sensitivity troponin testing (Hs-trop) was introduced in the United States in 2017 and has been adopted in American hospitals. Recent guidelines endorsed transition to Hs-trop to appropriately triage patients with chest pain. This study investigates differences in patient testing, myocardial infarction (MI) diagnoses, and health care utilization after transitioning to Hs-trop within 6 hospitals in a blended health system.
Methods: Patients 18 years or older presenting to the emergency department (ED) with chest pain during the study interval were included in the retrospective study if at least one troponin level was measured. A blended data approach was used – testing and health outcomes information was drawn from electronic health records while utilization information was procured from claims data. Downstream testing of echocardiograms, stress testing, coronary computed tomography angiography (CCTA), and invasive coronary angiography as well as diagnosis of MI types 1 and 2 were recorded and compared between patients before the implementation (N=7668) of Hs-trop and patients after the implementation of Hs-trop (N=7347). Multiple health care utilization and cost metrics were tracked following discharge for patients who were members of the Highmark Health Plan. Comparisons were done via weighted means and weighted standard deviations and weighted least squares regression.
Results: 15,015 patients were included in the study with a median age of 55 years, mostly white (77%) and female (54%). The post-implementation group had fewer troponin tests completed (2.2 vs 2.4); more elevated troponins (24.1% vs 13.6%); less likely to receive any subsequent cardiac diagnostic testing, including echocardiography (OR = 0.85), stress testing (OR = 0.76), or CCTA (OR = 0.69); more likely to be directly discharged from the ED (OR = 1.6); and less likely to return to the ED within 30 (OR=0.74) or 90 (OR=0.74) days post-discharge. Health care costs were not different between the two groups, but the post-implementation group utilized healthcare 9.7% less than the pre-implementation group (p<.0001)
Conclusion: Implementation of Hs-trop resulted in fewer tests and more ED discharges, and was associated with less healthcare utilization, indicating value for both patients and payors.