Abstract 14386: High Sensitivity Troponin: Implementation Before Education

Abstract

Introduction: Troponin T is strong indicator of Acute Myocardial Injury, however, concerns regarding its sensitivity have led to the inception of high sensitivity troponin (hscTn). The use of hscTn in clinical practice allows for an increased negative predictive value, which in turn can expedite triage and disposition of patients presenting with Acute Coronary Syndrome. The ACC/AHA have developed algorithms to provide a road map to aide in the interpretation of hscTn values and their indications. However, the understanding of the interpretation of test is integral hscTn in guiding management. Hypothesis: Evaluate if the implementation of hscTn within our hospital system decreased the amount of inappropriate diagnostic testing and admissions. Methods: A total of 602 patients consisting of two patient groups seen in our emergency department with the chief complaint of chest pain were studied. The troponin T group consisted of patient admitted between Jan 2021 to June 2021 (n=246) and the hscTn group between July 2021 - December 2021 (n=356). Baseline demographic and clinical comorbid characteristics were compared between both groups. Notable outcomes of interest were rates of admission as well as cardiac testing. Analysis was performed using T test for continuous variables and Chi squared test for categorical variables. Results: Admission rates were significantly increased in the hscTn group in comparison to the regular troponin group with proportions of 60.3% vs 39.7% respectively (p < 0.001). An 11 percent increase in inpatient cardiology consultation of the total visits occurred within the hscTn group vs the regular troponin group. When evaluating admitted patients, based on AHA guidelines for significant hscTn findings only 2% of those patients who were admitted met the criteria. Conclusions: The introduction of hscTn troponin within our hospital did not appear to decrease chest pain admissions regardless of its improved sensitivity and specificity. In contrast, rates were increased even when elevation was not significant, this may not be due to the test's efficacy but instead to the lack of education on its indications.