• Laura Warren, Brett G Fischer, Amos Shemesh, Jean Scofi, Nekee Pandya, Robert J Kim, Caroline Andy, Sophie Rand, Jim Yee, Stacia Semple, Amy Chadburn, He S Yang, Peter A D Steel, and Zhen Zhao.
• Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA.
• J Gen Intern Med. 2024 Apr 1; 39 (5): 739746739-746.

BackgroundGuidelines recommend high-sensitivity cardiac troponin (hs-cTn) for diagnosis of myocardial infarction. Use of hs-cTn is increasing across the U.S., but questions remain regarding clinical and operational impact. Prior studies have had methodologic limitations and yielded conflicting results.ObjectiveTo evaluate the impact of transitioning from conventional cardiac troponin (cTn) to hs-cTn on test and resource utilization, operational efficiency, and patient safety.DesignRetrospective cohort study in two New York City hospitals during the months before and after transition from conventional cTn to hs-cTn at Hospital 1. Hospital 2 served as a control.ParticipantsConsecutive emergency department (ED) patients with at least one cTn test resulted.InterventionMultifaceted hs-cTn intervention bundle, including a 0/2-h diagnostic algorithm for non-ST-elevation myocardial infarction, an educational bundle, enhancements to the electronic medical record, and nursing interventions to facilitate timed sample collection.Main MeasuresPrimary outcomes included serial cTn test utilization, probability of hospital admission, ED length of stay (LOS), and among discharged patients, probability of ED revisit within 72 h resulting in hospital admission. Multivariable regression models adjusted for age, sex, temporal trends, and interhospital differences.Key ResultsThe intervention was associated with increased use of serial cTn testing (adjusted risk difference: 48 percentage points, 95% CI: 45-50, P < 0.001) and ED LOS (adjusted geometric mean difference: 50 min, 95% CI: 50-51, P < 0.001). There was no significant association between the intervention and probability of admission (adjusted relative risk [aRR]: 0.99, 95% CI: 0.89-1.1, P = 0.81) or probability of ED revisit within 72 h resulting in admission (aRR: 1.1, 95% CI: 0.44-2.9, P = 0.81).ConclusionsImplementation of a hs-cTn intervention bundle was associated with an improvement in serial cTn testing, a neutral effect on probability of hospital admission, and a modest increase in ED LOS.© 2023. The Author(s), under exclusive licence to Society of General Internal Medicine.

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