Abstract 11905: Real-World Clinical Impact of High-Sensitivity Troponin for Chest Pain Evaluation in the Emergency Department

Abstract

Background: The impact of high-sensitivity cardiac troponin (hs-cTn) implementation on clinical practice in emergency departments in the United States is not well characterized. Research Questions: We sought to assess the effect of hs-cTn on length of stay, hospital admissions, and utilization of cardiac testing and consultations. Methods: Adult patient visits to the emergency department (ED) for chest pain with ≥ 1 troponin result were identified in electronic health record data from a large academic health system encompassing one suburban hospital and two urban hospitals including a quaternary referral center. Patients were included 15 months before and 11 months after the implementation of hs-cTn on April 6, 2022. Associations between hs-cTn implementation and clinical metrics were evaluated using both univariable and multivariable linear models. Results: Among 27,313 unique patients, there were 17,267 and 14,809 encounters before and after the implementation of hs-cTn, respectively. Using hs-cTn, a greater proportion of patients were discharged from the ED (59.5 % vs. 64.9 %, p <0.0001), and total length of stay ( Figure 1 ) was shorter (6.6 h, IQR 3.9 - 29.5 vs. 6.0 h, IQR 4.0 - 27.1, p = 0.039). Similar results were observed in urban vs. suburban settings and in quaternary care vs. lower levels of care. There were lower rates of cardiology consults (-1.2 per 100 patient visits, adjusted odds ratio [OR]: 0.91, 95% confidence interval [CI]: 0.86 - 0.97), echocardiograms (-2.8 per 100 patient visits, adjusted OR: 0.86, 95% CI: 0.82 - 0.91), stress tests (-1.9 per 100 patient visits, adjusted OR: 0.74, 95% CI: 0.67 - 0.81), and coronary angiograms (-2.0 per 100 patient visits, adjusted OR: 0.77, 95% CI: 0.70 - 0.83) after hs-cTn implementation. Conclusions: In real-world data, implementation of hs-cTn was associated with a higher rate of discharges from the ED and shorter total length of stay with small reductions in utilization of cardiac testing.