Healthcare and Resource Use in Patients With Stable High-Sensitivity Cardiac Troponin T Levels

Patients with elevated but stable levels of high-sensitivity cardiac troponin (hs-cTn) have a high risk of premature death and cardiovascular events. This study aimed to investigate the association between stable hs-cTnT levels and healthcare and resource use in patients with chest pain in the emergency department (ED). We included all patients who presented with chest pain and stable hs-cTnT levels without any concurrent acute medical condition at Karolinska University Hospital, Stockholm, Sweden, from 2011 to 2014. A negative binomial regression model was used to calculate incidence rates and incidence rate ratios with 95% confidence intervals (CIs) for the number of hospital visits, hospital days, and investigations performed during follow-up, in different categories of hs-cTnT levels (reference: hs-cTnT <5 ng/l). A total of 19,437 patients were included. During a follow-up of 4.1 years, 36,617 hospital visits and 206,808 hospital days were observed. Yearly rates of hospital visits and days gradually rose with increasing hs-cTnT levels from 0.3 and 1.27 (<5 ng/l) to 1.7 and 13 (≥50 ng/l) per person. In patients with hs-cTnT levels >14 ng/l, adjusted risks of in-hospital days were more than doubled (adjusted incidence rate ratio (95% CI) 2.31 (2.14 to 2.50), 2.88 (2.55 to 3.26), and 2.89 (2.45 to 3.40) in patients with hs-cTnT levels of 15 to 29, 30 to 49, and ≥50 ng/l, respectively) compared with the reference. Computed tomography, but not coronary angiography, increased with increasing hs-cTnT levels. In conclusion, stable hs-cTnT levels are associated with a higher rate of hospitalization, length of hospital stay, and resource use in patients with chest pain.