Key result
Detectable cardiac troponin was associated with increased mortality (HR 2.05, P<0.0001), and significant sex and race-based disparities were observed in the use of downstream cardiovascular services.
Why the study?
Does an elevated cardiac troponin level predict mortality and subsequent use of cardiovascular services, and are there sex or race-based disparities in care among hospitalized patients?
Cohort (n=26,663)
No
Does an elevated cardiac troponin level predict mortality and subsequent use of cardiovascular services, and are there sex or race-based disparities in care among hospitalized patients?
Elevated cardiac troponin in hospitalized patients is strongly associated with mortality, but the downstream utilization of cardiovascular services reveals significant sex and race-based disparities.
Answers are grounded in this paper and cite their sources.
Troponin detection may aid inpatient mortality prognostication; leaves open whether sex and race disparities in services reflect bias or appropriate care.
Background The impact of cardiac troponin (cTn) testing on the downstream use of cardiovascular services is not well understood. We conducted this large-scale single centre cohort study to investigate the patterns of testing that result from the use of cTn. Methods We conducted this investigation using data collected between 1 January 2013 and 18 December 2015 from an academically affiliated tertiary care centre. Data from all hospitalised patients evaluated with cTn (Roche Elecsys cTn-T) assay were collected from our integrated data repository and divided into two cohorts: all cTn assays negative (<0.03 µg/L) versus at least one elevated (≥0.03 µg/L). The main outcomes were the frequency of use cardiovascular services and mortality. Results Among 26 663 subjects, 18.6% had at least one elevated cTn assay; acute myocardial infarction was diagnosed in 3.9% overall. More men received cardiac catheterisation and cardiology consultation (OR 1.29, 95% CI 1.20 to 1.39 and OR 1.45, 95% CI 1.31 to 1.61) while African-American patients were less likely to have either catheterisation (OR 0.85, 95% CI 0.77 to 0.93) or consultation (OR 0.72, 95% CI 0.63 to 0.82) performed. Mortality was associated with detectable cTn (HR 2.05, P<0.0001). Conclusions Among hospitalised patients evaluated with cTn, we observed patterns of underuse and overuse of cardiovascular services. These patterns may have further relevance when high-sensitivity cTn assays are available in the USA. Sex and race-based disparities in cardiovascular services persist.
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Winchester et al. (2018) conducted a cohort in Hospitalised patients evaluated with cardiac troponin (n=26,663). Elevated cardiac troponin (≥0.03 µg/L) vs. Negative cardiac troponin (<0.03 µg/L) was evaluated on Mortality (HR 2.05, p=<0.0001). Detectable cardiac troponin was associated with increased mortality (HR 2.05, P<0.0001), and significant sex and race-based disparities were observed in the use of downstream cardiovascular services.
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