Paul Collinson1, Angelika Hammerer-Lercher2, Janne Suvisaari3, Fred S Apple4, Rob H Christenson5, Kari Pulkki6, Marja P van Dieijen-Visser7, Christopher J Duff8, Hannsjörg Baum9, Ana Stavljenic-Rukavina10, Kristin M Aakre11, Michel R Langlois12, Sanja Stankovic13, Paivi Laitinen3. 1. Departments of Chemical Pathology and Cardiology, St George's Hospital, London, UK; paul.collinson@stgeorges.nhs.uk. 2. Kantonspital Aarau AG, Aarau, Switzerland; 3. HUSLAB, Department of Clinical Chemistry, Helsinki University Central Hospital, Helsinki, Finland; 4. Departments of Laboratory Medicine and Pathology, Hennepin County Medical Center and University of Minnesota, Minneapolis, MN; 5. University of Maryland School of Medicine, Baltimore, MD; 6. University of Eastern Finland and Eastern Finland Laboratory Centre, Kuopio, Finland; 7. Maastricht University Medical Center, Maastricht, the Netherlands; 8. Department of Clinical Biochemistry, University Hospitals of North Midlands, Stoke-on-Trent, UK; 9. Regionale Kliniken Holding RKH GmbH, Ludwigsburg, Germany; 10. DIU Libertas International University, Zagreb, Croatia; 11. Haukeland University Hospital, Bergen, Norway; 12. Asklepios Core-lab, Department of Laboratory Medicine, AZ St-Jan Hospital Bruges and Ghent University, Ghent, Belgium; 13. Center for Medical Biochemistry, Clinical Center of Serbia, Belgrade, Serbia.
Abstract
BACKGROUND: We undertook an assessment of current use of evidence-based guidelines for the use of cardiac biomarkers in Europe (EU) and North America (NA). METHODS: In 2013-2014 a web-based questionnaire was distributed via NA and EU biochemical societies. Questions covered cardiac biomarkers measured, analytical methods used, decision thresholds, and use of decision-making protocols. Results were collated using a central database and analyzed using comparative and descriptive nonparametric statistics. RESULTS: In EU, returns were obtained from 442 hospitals, 50% central or university hospitals, and 39% from local hospitals from 35 countries with 395/442 (89%) provided an acute service. In NA there were 91 responses (63.7% central or university hospitals, 19.8% community hospitals) with 76/91 (83.5%) providing an acute service. Cardiac troponin was the preferred cardiac biomarker in 99.5% (EU) and 98.7% (NA), and the first line marker in 97.7% (EU) and 97.4% (NA). There were important differences in the choice of decision limits and their derivations. The origin of the information was also significantly different, with EU vs NA as follows: package insert, 61.9% vs 40%; publications, 17.1% vs 15.0%; local clinical or analytical validation choice, 21.0% vs 45.0%; P = 0.0003. CONCLUSIONS: There are significant differences between EU and NA use of cardiac biomarkers. This probably relates to different availability of assays between EU and NA (such as high-sensitivity troponin assays) and different laboratory practices on assay introduction (greater local evaluation of assay performance occurred in NA).
BACKGROUND: We undertook an assessment of current use of evidence-based guidelines for the use of cardiac biomarkers in Europe (EU) and North America (NA). METHODS: In 2013-2014 a web-based questionnaire was distributed via NA and EU biochemical societies. Questions covered cardiac biomarkers measured, analytical methods used, decision thresholds, and use of decision-making protocols. Results were collated using a central database and analyzed using comparative and descriptive nonparametric statistics. RESULTS: In EU, returns were obtained from 442 hospitals, 50% central or university hospitals, and 39% from local hospitals from 35 countries with 395/442 (89%) provided an acute service. In NA there were 91 responses (63.7% central or university hospitals, 19.8% community hospitals) with 76/91 (83.5%) providing an acute service. Cardiac troponin was the preferred cardiac biomarker in 99.5% (EU) and 98.7% (NA), and the first line marker in 97.7% (EU) and 97.4% (NA). There were important differences in the choice of decision limits and their derivations. The origin of the information was also significantly different, with EU vs NA as follows: package insert, 61.9% vs 40%; publications, 17.1% vs 15.0%; local clinical or analytical validation choice, 21.0% vs 45.0%; P = 0.0003. CONCLUSIONS: There are significant differences between EU and NA use of cardiac biomarkers. This probably relates to different availability of assays between EU and NA (such as high-sensitivity troponin assays) and different laboratory practices on assay introduction (greater local evaluation of assay performance occurred in NA).
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