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OVERUSE AND UNDERUSE OF CARDIOVASCULAR SERVICES ASSOCIATED WITH ELEVATION IN CARDIAC TROPONIN
49 JACC March 21, 2017 Volume 69, Issue 11
Acute and Stable Ischemic Heart Disease OVERUSE AND UNDERUSE OF CARDIOVASCULAR SERVICES ASSOCIATED WITH ELEVATION IN CARDIAC TROPONIN Poster Contributions Poster Hall, Hall C Friday, March 17, 2017, 10:00 a.m.-10:45 a.m. Session Title: Updates in Stable Ischemic Heart Disease Abstract Category: 3. Acute and Stable Ischemic Heart Disease: Therapy Presentation Number: 1125-309 Authors: David E. Winchester, Kristopher Kline, Christopher Estel, Sean M. Taasan, Jingnan Zhang, Jonathan Shuster, University of Florida, Gainesville, FL, USA
Background: Measurement of cardiac troponin (cTn) is widely used to diagnose acute coronary syndromes. Little is known about overuse and underuse of cardiovascular services and how care patterns are altered when cTn is elevated. Methods: We analyzed 26,663 consecutive adult patients hospitalized and evaluated with cTn-T between 2012 and 2015. Patients were divided into two cohorts, those with all cTn negative (i.e., <0.03 ng/mL) and those with any elevated cTn value. The primary outcome was to compare the rates of cardiovascular service use (e.g., electrocardiograms [ECG], consults, angiography, etc.) between the cohorts. We used logistic regression models to determine independent variables associated with cardiology consultation. Results: Patients were mostly white (72.7%) with equal distribution of sex (female 50.1%). Elevated cTn was seen in 4,962 (18.6%) patients. Cardiology consult was more likely for an elevated cTn (10.2% vs. 29.6%, odds ratio [OR] 3.72, p<0.0001). ECGs were ordered for only 75.6% of the total population (OR 1.27, p<0.0001 for patients with elevated cTn). Echocardiograms were ordered more frequently for the elevated cTn cohort (52.6% vs. 79.4%, OR=3.46, p<0.0001). Among patients with elevated cTn, only 20.8% underwent coronary angiography (vs. 3.5% for no cTn elevation, OR=7.14, p<0.0001). With logistic regression, several factors including elevated cTn (OR=3.44, p<0.0001) were associated with cardiology consultation. Conclusions: Only one fifth of patients evaluated with cTn have an elevated value and only one fifth of those with elevated cTn undergo coronary angiography. A substantial portion of patients with elevated cTn did not receive an ECG during their hospitalization. The sizable majority of patients with elevated cTn are not evaluated with cardiology consultation although many undergo echocardiography. This investigation presents evidence for widespread overuse and underuse of both cTn and subsequent cardiovascular services.
Acute and Stable Ischemic Heart Disease OVERUSE AND UNDERUSE OF CARDIOVASCULAR SERVICES ASSOCIATED WITH ELEVATION IN CARDIAC TROPONIN Poster Contributions Poster Hall, Hall C Friday, March 17, 2017, 10:00 a.m.-10:45 a.m. Session Title: Updates in Stable Ischemic Heart Disease Abstract Category: 3. Acute and Stable Ischemic Heart Disease: Therapy Presentation Number: 1125-309 Authors: David E. Winchester, Kristopher Kline, Christopher Estel, Sean M. Taasan, Jingnan Zhang, Jonathan Shuster, University of Florida, Gainesville, FL, USA
Background: Measurement of cardiac troponin (cTn) is widely used to diagnose acute coronary syndromes. Little is known about overuse and underuse of cardiovascular services and how care patterns are altered when cTn is elevated. Methods: We analyzed 26,663 consecutive adult patients hospitalized and evaluated with cTn-T between 2012 and 2015. Patients were divided into two cohorts, those with all cTn negative (i.e., <0.03 ng/mL) and those with any elevated cTn value. The primary outcome was to compare the rates of cardiovascular service use (e.g., electrocardiograms [ECG], consults, angiography, etc.) between the cohorts. We used logistic regression models to determine independent variables associated with cardiology consultation. Results: Patients were mostly white (72.7%) with equal distribution of sex (female 50.1%). Elevated cTn was seen in 4,962 (18.6%) patients. Cardiology consult was more likely for an elevated cTn (10.2% vs. 29.6%, odds ratio [OR] 3.72, p<0.0001). ECGs were ordered for only 75.6% of the total population (OR 1.27, p<0.0001 for patients with elevated cTn). Echocardiograms were ordered more frequently for the elevated cTn cohort (52.6% vs. 79.4%, OR=3.46, p<0.0001). Among patients with elevated cTn, only 20.8% underwent coronary angiography (vs. 3.5% for no cTn elevation, OR=7.14, p<0.0001). With logistic regression, several factors including elevated cTn (OR=3.44, p<0.0001) were associated with cardiology consultation. Conclusions: Only one fifth of patients evaluated with cTn have an elevated value and only one fifth of those with elevated cTn undergo coronary angiography. A substantial portion of patients with elevated cTn did not receive an ECG during their hospitalization. The sizable majority of patients with elevated cTn are not evaluated with cardiology consultation although many undergo echocardiography. This investigation presents evidence for widespread overuse and underuse of both cTn and subsequent cardiovascular services.