Implementation of High-Sensitivity Cardiac Troponin: Challenges From the International Experience

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Abstract

OBJECTIVE: Implementation of the newly approved high-sensitivity cardiac troponin (hs-cTn) in the United States presents a challenge for clinical practice. Sex-specific cutoffs, clinical protocols, and workflows will likely require modifications before implementation. METHODS: We conducted a cross-sectional survey of international physicians and laboratorians already utilizing hs-cTn for the evaluation of acute myocardial infarction. RESULTS: Twenty-two of 54 (41%) eligible participants completed the survey, representing 9 countries and 18 hospitals. All reported successful hs-cTn implementation and diagnostic utility (mean 8.6 + 1.2 out of 10 for best implementation). The major perceived benefit was more rapid evaluation of acute myocardial infarction (14/19, 74%), and the most frequently cited limitation was an increase in the number of measurable hs-cTn values that required further evaluation (8/18, 44%). Institutions using the hs-cTnI assay favored sex-specific cutoffs (5/6, 83%), whereas institutions employing the hs-cTnT assay favored a combined cutoff (12/12, 100%). Timing of serial hs-cTn measurements varied, with 0-3 hours (8/17, 47%) most frequent, followed by 0-2 hours (4/17, 24%), 0-1 hour (3/17, 18%), and other (2/17, 12%). CONCLUSIONS: Our survey of hs-cTn implementation at international institutions reveals satisfaction with new assays but reflects important variations in clinical practice. The use of sex-specific vs. combined cutoffs and timing of serial hs-cTn measurements varies across institutions and are subjects that United States centers must define without consensus from international practices.

Original languageEnglish (US)
Pages (from-to)173-178
Number of pages6
JournalCritical Pathways in Cardiology
Volume17
Issue number4
DOIs
StatePublished - Dec 1 2018

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Troponin
Myocardial Infarction
Workflow
Clinical Protocols
Consensus
Cross-Sectional Studies
Physicians

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

@article{cc2c14cc82d34eaeabca13be142571cb,
title = "Implementation of High-Sensitivity Cardiac Troponin: Challenges From the International Experience",
abstract = "OBJECTIVE: Implementation of the newly approved high-sensitivity cardiac troponin (hs-cTn) in the United States presents a challenge for clinical practice. Sex-specific cutoffs, clinical protocols, and workflows will likely require modifications before implementation. METHODS: We conducted a cross-sectional survey of international physicians and laboratorians already utilizing hs-cTn for the evaluation of acute myocardial infarction. RESULTS: Twenty-two of 54 (41{\%}) eligible participants completed the survey, representing 9 countries and 18 hospitals. All reported successful hs-cTn implementation and diagnostic utility (mean 8.6 + 1.2 out of 10 for best implementation). The major perceived benefit was more rapid evaluation of acute myocardial infarction (14/19, 74{\%}), and the most frequently cited limitation was an increase in the number of measurable hs-cTn values that required further evaluation (8/18, 44{\%}). Institutions using the hs-cTnI assay favored sex-specific cutoffs (5/6, 83{\%}), whereas institutions employing the hs-cTnT assay favored a combined cutoff (12/12, 100{\%}). Timing of serial hs-cTn measurements varied, with 0-3 hours (8/17, 47{\%}) most frequent, followed by 0-2 hours (4/17, 24{\%}), 0-1 hour (3/17, 18{\%}), and other (2/17, 12{\%}). CONCLUSIONS: Our survey of hs-cTn implementation at international institutions reveals satisfaction with new assays but reflects important variations in clinical practice. The use of sex-specific vs. combined cutoffs and timing of serial hs-cTn measurements varies across institutions and are subjects that United States centers must define without consensus from international practices.",
author = "Howell, {Stacey J.} and Amsterdam, {Ezra A} and Bryn Mumma and Lopez, {Javier E} and Nam Tran",
year = "2018",
month = "12",
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doi = "10.1097/HPC.0000000000000156",
language = "English (US)",
volume = "17",
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journal = "Critical Pathways in Cardiology",
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TY - JOUR

T1 - Implementation of High-Sensitivity Cardiac Troponin

T2 - Challenges From the International Experience

AU - Howell, Stacey J.

AU - Amsterdam, Ezra A

AU - Mumma, Bryn

AU - Lopez, Javier E

AU - Tran, Nam

PY - 2018/12/1

Y1 - 2018/12/1

N2 - OBJECTIVE: Implementation of the newly approved high-sensitivity cardiac troponin (hs-cTn) in the United States presents a challenge for clinical practice. Sex-specific cutoffs, clinical protocols, and workflows will likely require modifications before implementation. METHODS: We conducted a cross-sectional survey of international physicians and laboratorians already utilizing hs-cTn for the evaluation of acute myocardial infarction. RESULTS: Twenty-two of 54 (41%) eligible participants completed the survey, representing 9 countries and 18 hospitals. All reported successful hs-cTn implementation and diagnostic utility (mean 8.6 + 1.2 out of 10 for best implementation). The major perceived benefit was more rapid evaluation of acute myocardial infarction (14/19, 74%), and the most frequently cited limitation was an increase in the number of measurable hs-cTn values that required further evaluation (8/18, 44%). Institutions using the hs-cTnI assay favored sex-specific cutoffs (5/6, 83%), whereas institutions employing the hs-cTnT assay favored a combined cutoff (12/12, 100%). Timing of serial hs-cTn measurements varied, with 0-3 hours (8/17, 47%) most frequent, followed by 0-2 hours (4/17, 24%), 0-1 hour (3/17, 18%), and other (2/17, 12%). CONCLUSIONS: Our survey of hs-cTn implementation at international institutions reveals satisfaction with new assays but reflects important variations in clinical practice. The use of sex-specific vs. combined cutoffs and timing of serial hs-cTn measurements varies across institutions and are subjects that United States centers must define without consensus from international practices.

AB - OBJECTIVE: Implementation of the newly approved high-sensitivity cardiac troponin (hs-cTn) in the United States presents a challenge for clinical practice. Sex-specific cutoffs, clinical protocols, and workflows will likely require modifications before implementation. METHODS: We conducted a cross-sectional survey of international physicians and laboratorians already utilizing hs-cTn for the evaluation of acute myocardial infarction. RESULTS: Twenty-two of 54 (41%) eligible participants completed the survey, representing 9 countries and 18 hospitals. All reported successful hs-cTn implementation and diagnostic utility (mean 8.6 + 1.2 out of 10 for best implementation). The major perceived benefit was more rapid evaluation of acute myocardial infarction (14/19, 74%), and the most frequently cited limitation was an increase in the number of measurable hs-cTn values that required further evaluation (8/18, 44%). Institutions using the hs-cTnI assay favored sex-specific cutoffs (5/6, 83%), whereas institutions employing the hs-cTnT assay favored a combined cutoff (12/12, 100%). Timing of serial hs-cTn measurements varied, with 0-3 hours (8/17, 47%) most frequent, followed by 0-2 hours (4/17, 24%), 0-1 hour (3/17, 18%), and other (2/17, 12%). CONCLUSIONS: Our survey of hs-cTn implementation at international institutions reveals satisfaction with new assays but reflects important variations in clinical practice. The use of sex-specific vs. combined cutoffs and timing of serial hs-cTn measurements varies across institutions and are subjects that United States centers must define without consensus from international practices.

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U2 - 10.1097/HPC.0000000000000156

DO - 10.1097/HPC.0000000000000156

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EP - 178

JO - Critical Pathways in Cardiology

JF - Critical Pathways in Cardiology

SN - 1535-282X

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