Observational studyJournal of the American College of Cardiology2021
Downstream Cascades of Care Following High-Sensitivity Troponin Test Implementation.
Observational study in Journal of the American College of Cardiology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
18 citing papers in PubMed, 2 syntheses or guidelines pooled it, 33 citations in OpenAlex.
- Pooled it
- 2022 ACC Expert Consensus Decision Pathway on the Evaluation and Disposition of Acute Chest Pain in the Emergency Department: A Report of the American College of Cardiology Solution Set Oversight Committee.Journal of the American College of Cardiology · 2022Guideline
- Clinical and Economic Implications of High-Sensitivity Troponin-Informed Admission Strategies in Non-AMI Chest Pain.Journal of cardiovascular development and disease · 2026Article
- Introduction of High-Sensitivity Troponin Assay to Rural Tertiary Care Medical Center: Impact on Subsequent Cardiac Diagnostic Testing.Diagnostics (Basel, Switzerland) · 2026Article
- Test Ordering and Completion During Virtual vs In-Person Annual Visits.JAMA network open · 2026Article
- Implementation of a High-Sensitivity Troponin Assay and Its Association With Resource Utilization in Patients With Suspected Acute Coronary Syndrome.Mayo Clinic proceedings. Innovations, quality & outcomes · 2025Article
- Validation of a 0-/2-Hour High-Sensitivity Cardiac Troponin Algorithm for Suspected Acute Coronary Syndrome in the Emergency Department.Journal of the American Heart Association · 2025Article
- Emergency Department Implementation of a Multimodal Electronic Health Record-Integrated Clinical Intervention for High-Sensitivity Troponin Testing Increases Diagnostic Efficiency.Journal of the American College of Emergency Physicians open · 2025Article
- High-Sensitivity Cardiac Troponin Assays: From Implementation to Resource Utilization and Cost Effectiveness.The journal of applied laboratory medicine · 2025Review
- Clinical Outcomes, Healthcare Utilization, and Cost Following Implementation of a High-Sensitivity Cardiac Troponin Assay.Clinical cardiology · 2025Article
- A patient-centric chest pain management approach utilizing a high sensitivity Troponin-I assay.Heliyon · 2024Article
- High-Sensitivity Cardiac Troponin T Reporting, Clinical Outcomes, and Health Care Resource Use.JAMA network open · 2024Article
- Frequency, compliance, and yield of cardiac testing after high-sensitivity troponin accelerated diagnostic protocol implementation.The American journal of emergency medicine · 2023Article
- Implementation of High-Sensitivity Cardiac Troponin Assays in the United States.Journal of the American College of Cardiology · 2023Article
- Advances in Clinical Cardiology 2021: A Summary of Key Clinical Trials.Advances in therapy · 2022Review
- Emergency Department Management of Chest Pain With a High-Sensitivity Troponin-Enabled 0/1-Hour Rule-Out Algorithm.American journal of clinical pathology · 2022Article
- Downstream Mammary and Extramammary Cascade Services and Spending Following Screening Breast Magnetic Resonance Imaging vs Mammography Among Commercially Insured Women.JAMA network open · 2022Article
- Cost effectiveness of a 1-hour high-sensitivity troponin-T protocol: An analysis of the RAPID-TnT trial.International journal of cardiology. Heart & vasculature · 2022Article
Corrections and comments
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Authors and funding
8 authors at 4 institutions in 1 country.
Funding
Abstract
backgroundPatients with chest pain are often evaluated for acute myocardial infarction through troponin testing, which may prompt downstream services (cascades) of uncertain value.
objectivesThis study sought to determine the association of high-sensitivity cardiac troponin (hs-cTn) assay implementation with cascade events.
methodsUsing electronic health record and billing data, this study examined patient-visits to 5 emergency departments from April 1, 2017, to April 1, 2019. Difference-in-differences analysis compared patient-visits for chest pain (n = 7,564) to patient-visits for other symptoms (n = 100,415) (irrespective of troponin testing) before and after hs-cTn assay implementation. Outcomes included presence of any cascade event potentially associated with an initial hs-cTn test (primary), individual cascade events, length of stay, and spending on cardiac services.
resultsFollowing hs-cTn implementation, patients with chest pain had a 2.8% (95% confidence interval [CI]: 0.72% to 4.9%) net increase in experiencing any cascade event. They were more likely to have multiple troponin tests (10.5%; 95% CI: 9.0% to 12.0%) and electrocardiograms (7.1 per 100 patient-visits; 95% CI: 1.8 to 12.4). However, they received net fewer computed tomography scans (-1.5 per 100 patient-visits; 95% CI: -1.8 to -1.1), stress tests (-5.9 per 100 patient-visits; 95% CI: -6.5 to -5.3), and percutaneous coronary intervention (PCI) (-0.65 per 100 patient-visits; 95% CI: -1.01 to -0.30) and were less likely to receive cardiac medications, undergo cardiology evaluation (-3.5%; 95% CI: -4.5% to 2.6%), or be hospitalized (-5.8%; 95% CI: -7.7% to -3.8%). Patients with chest pain had lower net mean length of stay (-0.24 days; 95% CI: -0.32 to -0.16) but no net change in spending.
conclusionsHs-cTn assay implementation was associated with more net upfront tests yet fewer net stress tests, PCI, cardiology evaluations, and hospital admissions in patients with chest pain relative to patients with other symptoms.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.