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.
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.
Effect estimate: HR 2.05
p-value: p=<0.0001
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.
Winchester et al. (Mon,) 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.