BACKGROUND: The role of troponin quantification in evaluation of patients with suspected acute coronary syndrome is established, but with cost implications. Emerging high-sensitivity troponin and novel multi-marker assays herald further resource implications. AIMS: The objective of this study was to quantify recent trends in troponin usage and costs in a cross-section of hospitals. METHODS: A cross-sectional survey seeking data on troponin usage and costs from six tertiary referral, public access teaching hospitals for consecutive years between 2003 and 2009 was carried out. RESULTS: A median annual increase in the volume of troponin assays requested was identified in all six hospitals, with an average median annual increase of 6.9 % across hospitals (interquartile range 3.4, 10.1 %). This annual increase was not accompanied by a corresponding increase in volume of patients presenting to the Emergency Department (ED) with chest pain. The majority (44-67 %) of troponin requests originated in the ED of hospitals. The median annual spend on troponins per hospital was <euro>115,612 (interquartile range <euro>80,452, <euro>140,918). An analysis of results of assays performed in one centre found that the majority (91 %) of troponin assays performed were in the normal range. CONCLUSIONS: An annual increase in troponin requests without a corresponding increase in patient activity raises the possibility of increasingly indiscriminate troponin testing. The cumulative direct and indirect costs of inappropriate testing are significant. Corrective strategies are necessary to improve patient selection and testing protocols, particularly in the advent of the high-sensitivity troponin assays and novel multi-marker strategies.
BACKGROUND: The role of troponin quantification in evaluation of patients with suspected acute coronary syndrome is established, but with cost implications. Emerging high-sensitivity troponin and novel multi-marker assays herald further resource implications. AIMS: The objective of this study was to quantify recent trends in troponin usage and costs in a cross-section of hospitals. METHODS: A cross-sectional survey seeking data on troponin usage and costs from six tertiary referral, public access teaching hospitals for consecutive years between 2003 and 2009 was carried out. RESULTS: A median annual increase in the volume of troponin assays requested was identified in all six hospitals, with an average median annual increase of 6.9 % across hospitals (interquartile range 3.4, 10.1 %). This annual increase was not accompanied by a corresponding increase in volume of patients presenting to the Emergency Department (ED) with chest pain. The majority (44-67 %) of troponin requests originated in the ED of hospitals. The median annual spend on troponins per hospital was <euro>115,612 (interquartile range <euro>80,452, <euro>140,918). An analysis of results of assays performed in one centre found that the majority (91 %) of troponin assays performed were in the normal range. CONCLUSIONS: An annual increase in troponin requests without a corresponding increase in patient activity raises the possibility of increasingly indiscriminate troponin testing. The cumulative direct and indirect costs of inappropriate testing are significant. Corrective strategies are necessary to improve patient selection and testing protocols, particularly in the advent of the high-sensitivity troponin assays and novel multi-marker strategies.
Authors: Kristian Thygesen; Johannes Mair; Hugo Katus; Mario Plebani; Per Venge; Paul Collinson; Bertil Lindahl; Evangelos Giannitsis; Yonathan Hasin; Marcello Galvani; Marco Tubaro; Joseph S Alpert; Luigi M Biasucci; Wolfgang Koenig; Christian Mueller; Kurt Huber; Christian Hamm; Allan S Jaffe Journal: Eur Heart J Date: 2010-08-03 Impact factor: 29.983
Authors: Till Keller; Stergios Tzikas; Tanja Zeller; Ewa Czyz; Lars Lillpopp; Francisco M Ojeda; Alexander Roth; Christoph Bickel; Stephan Baldus; Christoph R Sinning; Philipp S Wild; Edith Lubos; Dirk Peetz; Jan Kunde; Oliver Hartmann; Andreas Bergmann; Felix Post; Karl J Lackner; Sabine Genth-Zotz; Viviane Nicaud; Laurence Tiret; Thomas F Münzel; Stefan Blankenberg Journal: J Am Coll Cardiol Date: 2010-05-11 Impact factor: 24.094
Authors: J H Pope; T P Aufderheide; R Ruthazer; R H Woolard; J A Feldman; J R Beshansky; J L Griffith; H P Selker Journal: N Engl J Med Date: 2000-04-20 Impact factor: 91.245
Authors: James L Januzzi; Fabian Bamberg; Hang Lee; Quynh A Truong; John H Nichols; Mahir Karakas; Asim A Mohammed; Christopher L Schlett; John T Nagurney; Udo Hoffmann; Wolfgang Koenig Journal: Circulation Date: 2010-03-01 Impact factor: 29.690
Authors: Till Keller; Tanja Zeller; Dirk Peetz; Stergios Tzikas; Alexander Roth; Ewa Czyz; Christoph Bickel; Stephan Baldus; Ascan Warnholtz; Meike Fröhlich; Christoph R Sinning; Medea S Eleftheriadis; Philipp S Wild; Renate B Schnabel; Edith Lubos; Nicole Jachmann; Sabine Genth-Zotz; Felix Post; Viviane Nicaud; Laurence Tiret; Karl J Lackner; Thomas F Münzel; Stefan Blankenberg Journal: N Engl J Med Date: 2009-08-27 Impact factor: 91.245
Authors: Kenneth Dickstein; Alain Cohen-Solal; Gerasimos Filippatos; John J V McMurray; Piotr Ponikowski; Philip Alexander Poole-Wilson; Anna Strömberg; Dirk J van Veldhuisen; Dan Atar; Arno W Hoes; Andre Keren; Alexandre Mebazaa; Markku Nieminen; Silvia Giuliana Priori; Karl Swedberg Journal: Eur Heart J Date: 2008-09-17 Impact factor: 29.983
Authors: Philip W Chui; Denise Esserman; Lori A Bastian; Jeptha P Curtis; Parul U Gandhi; Lindsey Rosman; Nihar Desai; Ronald G Hauser Journal: Med Care Date: 2020-12 Impact factor: 3.178
Authors: Graham R Lee; Tara Ca Browne; Berna Guest; Imran Khan; Eamon Murphy; Catherine McGorrian; Niall G Mahon; Maria C Fitzgibbon Journal: Pract Lab Med Date: 2016-01-13