Clinical Outcomes, Healthcare Utilization, and Cost Following Implementation of a High-Sensitivity Cardiac Troponin Assay

Abstract

Introduction

High-sensitivity troponin (Hs-trop) protocols have been developed for the cardiac evaluation of chest pain patients presenting to emergency departments (ED), but uptake has been suboptimal.

Methods

This retrospective study sought to evaluate the effects of an Hs-trop protocol (Roche Gen-5 troponin assay) implementation on patient outcomes, healthcare utilization, and costs. Patients presenting to EDs with chest pain following implementation of an Hs-trop protocol (POST) were compared to control patients presenting in the year prior (PRE). Study endpoints included troponin elevations, cardiac diagnostic testing, and ED disposition. Among patients discharged directly from the ED, 30- and 90-day death, new myocardial infarction (MI), ED returns, and hospital admissions were compared. In a subset with insurance data, post-discharge healthcare costs and utilization were compared.

Results

Among 15 015 patients meeting study criteria, there were no differences in MI diagnoses POST versus PRE, but myocardial injury without MI was more frequent POST (aOR = 9.03; 95% CI: 7.44, 10.96). Noninvasive cardiac testing at the index ED encounter was less frequent POST (aOR = 0.72; 0.67, 0.78), with no difference for invasive angiography. Among patients directly discharged from the ED, no differences were observed for death, but POST patients had fewer ED returns (aOR = 0.70; 0.59, 0.83) and hospital admissions (aOR = 0.62; 0.45, 0.85) within 30 days. Overall healthcare utilization was 8.4% lower in the POST group (p < 0.001) but costs were not different.

Conclusions

Following implementation of an Hs-trop protocol, decreases were observed in noninvasive cardiac testing, and ED returns and hospital admissions within 90 days of discharge, without compromising outcomes. Overall healthcare utilization declined.