Abstract 10048: Effect of Transitioning From Conventional Cardiac Troponin to High Sensitivity Cardiac Troponin on Hospital Resources- A Single Center Experience

Abstract

Introduction: In comparison to conventional cardiac troponin (cTn), high sensitivity cardiac troponin (hs-cTn) assay is associated with improved detection of myocardial infarction (MI). From literature review, resource utilization seems variable across institutions. This study sought to determine the effect of converting to hs-cTn on hospital resources. Hypothesis: hs-cTn is associated with overall decrease in resource utilization Methods: We performed a descriptive retrospective analysis of resource utilization at Rush University Medical Center (Chicago, IL) over the period of transition (July 6, 2021) from a cTn to hs-cTn assay using data extracted from the electronic health record. Inclusion criteria included Emergency Department (ED) encounters between January 1, 2021 and December 31, 2021 with chief complaints of “chest pain” or “dyspnea” with an associated troponin order. The primary endpoints were percentage of ED discharges. Secondary endpoints included the number of cardiac studies ordered including troponins, electrocardiograms (ECG), echocardiograms, stress tests, and coronary angiograms. Univariable comparisons of these endpoints were performed using Student’s t-test for continuous variables and Chi-square tests for binary/categorical variables. Results: A total of 5113 encounters were analyzed. hs-cTn was associated with an overall increased ED discharge in patients with negative troponin tests (44.1% vs. 29.9%, P<0.01). In terms of cardiac testing per encounter, hs-cTn compared to cTn was associated with a marginal increase in number of troponin tests (1.9 vs. 1.6, P<0.01), electrocardiograms (3.0 vs. 2.9, P=0.01), Echocardiograms (0.5 vs. 0.4, P<0.01). There was a decrease in the utilization of stress testing (0.21 vs 0.26, P<0.01). There was a trend towards increased coronary angiography per encounter (0.11 vs. 0.09, P=0.05) and an increase in total coronary angiography use during the hs-cTn period compared to cTn (227//2471 (9.2%) vs. 195/2642 (7.4%, P=0.02)) Conclusion: Transitioning from cTn to hs-cTn was associated with increased ED discharges, marginal increase in troponin tests, ECGs, echocardiograms. There was a decrease in stress testing but increase in total coronary angiography.