An accelerated 0/1-hour hs-cTnT protocol did not significantly differ from a 0/3-hour protocol for all-cause mortality or new/recurrent MI (3.8% vs 5.0%; HR 1.32; 95% CI 0.95-1.83; P=0.100).
RCT (n=3,265)
randomised
Does a 0/1-hour hs-cTnT protocol reduce costs or improve clinical outcomes compared to a conventional 0/3-hour protocol in patients with suspected ACS?
An accelerated 0/1-hour hs-cTnT protocol for suspected ACS reduced ED length of stay but did not significantly reduce overall 12-month healthcare costs or improve clinical outcomes compared to a 0/3-hour protocol.
Hazard Ratio: 1.32 (95% CI 0.95–1.83)
Absolute Event Rate: 3.8% vs 5%
p-value: p=0.100
BACKGROUND: To understand the economic impact of an accelerated 0/1-hour high-sensitivity troponin-T (hs-cTnT) protocol. OBJECTIVE: To conduct a patient-level economic analysis of the RAPID-TnT randomised trial in patients presenting with suspected acute coronary syndrome (ACS). METHODS: An economic evaluation was conducted with 3265 patients randomised to either the 0/1-hour hs-cTnT protocol (n = 1634) or the conventional 0/3-hour standard-of-care protocol (n = 1631) with costs reported in Australian dollars. The primary clinical outcome was all-cause mortality or new/recurrent myocardial infarction. RESULTS: Over 12-months, mean per patient costs were numerically higher in the 0/1-hour arm compared to the conventional 0/3-hour arm (by 472. 49/patient, 95% confidence interval 95 %CI: -1, 380. 15 to 2, 325. 13, P = 0. 617) with no statistically significant difference in primary outcome (0/1-hour: 62/1634 3. 8%, 0/3-hour: 82/1631 5. 0%, HR: 1. 32 95 %CI: 0. 95-1. 83, P = 0. 100). The mean emergency department (ED) length of stay (LOS) was significantly lower in the 0/1-hour arm (by 0. 62 h/patient, 95 %CI: 0. 85 to 0. 39, P < 0. 001), but the subsequent 12-month unplanned inpatient costs was numerically higher (by 891. 22/patient, 95 %CI: -96. 07 to 1, 878. 50, P = 0. 077). Restricting the analysis to patients with hs-cTnT concentrations ≤ 29 ng/L, mean per patient cost remained numerically higher in the 0/1-hour arm (by 152. 44/patient, 95 %CI: -1, 793. 11 to 2, 097. 99, P = 0. 988), whilst the reduction in ED LOS was more pronounced (by 0. 70 h/patient, 95 %CI: 0. 45-0. 95, P < 0. 001). CONCLUSIONS: There were no differences in resource utilization between the 0/1-hour hs-cTnT protocol versus the conventional 0/3-hour protocol for the assessment of suspected ACS, despite improved initial ED efficiency. Further refinements in strategies to improve clinical outcomes and subsequent management efficiency are needed.
Chuang et al. (Wed,) conducted a rct in suspected acute coronary syndrome (ACS) (n=3,265). 0/1-hour high-sensitivity troponin-T (hs-cTnT) protocol vs. conventional 0/3-hour standard-of-care protocol was evaluated on all-cause mortality or new/recurrent myocardial infarction (HR 1.32, 95% CI 0.95-1.83, p=0.100). An accelerated 0/1-hour hs-cTnT protocol did not significantly differ from a 0/3-hour protocol for all-cause mortality or new/recurrent MI (3.8% vs 5.0%; HR 1.32; 95% CI 0.95-1.83; P=0.100).