High-Sensitivity Troponin: Six Lessons and a Reading
The introduction of hsTn testing is already happening in many hospitals in the UK and will undoubtedly change management. Due to the increased sensitivity of these assays it is likely that the rate of MI diagnosis will increase. Some authors suggest that large increases in MI rates are possible, between 10% and 47%.
However, it is not entirely clear what the clinical implications are in these patients with very low troponin elevations of less than 50 ng/L. One study showed that patients reclassified as MI had significantly better outcomes when clinicians acted on these results. However, this was based on a change of troponin threshold from 200 ng/L down to 50 ng/L, and hsTn tests measure levels down to a quarter of this level.
Use of hsTn is also almost certainly financially beneficial. An accurate diagnosis can be made at an earlier stage, potentially reducing length of stay. This should also increase the number of patients discharged on the same day as admission, which carries a tariff benefit in the National Health Service (NHS) system. A modelling study found that early hsTn testing was financially beneficial in almost all cases. It is likely that the next update of the UK National Institute for Health and Clinical Excellence (NICE) guidelines on the assessment and management of chest pain will assess hsTn testing.
5. It Has Significant Implications for MI Diagnosis and Management
The introduction of hsTn testing is already happening in many hospitals in the UK and will undoubtedly change management. Due to the increased sensitivity of these assays it is likely that the rate of MI diagnosis will increase. Some authors suggest that large increases in MI rates are possible, between 10% and 47%.
However, it is not entirely clear what the clinical implications are in these patients with very low troponin elevations of less than 50 ng/L. One study showed that patients reclassified as MI had significantly better outcomes when clinicians acted on these results. However, this was based on a change of troponin threshold from 200 ng/L down to 50 ng/L, and hsTn tests measure levels down to a quarter of this level.
Use of hsTn is also almost certainly financially beneficial. An accurate diagnosis can be made at an earlier stage, potentially reducing length of stay. This should also increase the number of patients discharged on the same day as admission, which carries a tariff benefit in the National Health Service (NHS) system. A modelling study found that early hsTn testing was financially beneficial in almost all cases. It is likely that the next update of the UK National Institute for Health and Clinical Excellence (NICE) guidelines on the assessment and management of chest pain will assess hsTn testing.
SHARE
