Reducing Excess Cardiac Biomarker Testing at an Academic Medical Center

Trends in Use of Biomarker Protocols for the Evaluation of Possible Myocardial Infarction

“…Before the development of more-sensitive cTn assays, varying combinations of cTn, CK-MB, and myoglobin have been used to improve early diagnostic sensitivity and reduce the time to rule-out AMI. However, contemporary cTn assays have high early diagnostic accuracy, such that use of other markers adds cost [14][15][16] without providing additional diagnostic utility. 17,18 This led the 2014 American College of Cardiology/American Heart Association non-ST-segment elevation myocardial infarction guidelines to indicate that there is no benefit (class III recommendation) of using myoglobin and CK-MB, supported with a grade A level of evidence.…”

Electronic Medical Record–Based Performance Improvement Project to Document and Reduce Excessive Cardiac Troponin Testing

“…This would indicate that within this alerting cohort, a conservative estimate of 32% of the cTnI results were unnecessary and therefore cTnI was overutilized. This volume of wasteful testing is a considerable financial burden, estimated to be hundreds of thousands of dollars a year, affecting both patient charges and hospital direct costs, without adding value to patient care (14,15 ). On the basis of the evidencebased Third Universal Definition of Myocardial Infarction guidelines, and in light of the fact that 53% of BPAs were generated before there were 2 cTnI results, a substantial number of providers were requesting additional cTnI testing without having sufficient data to provide a clear picture of rising/falling pattern within the cTnI results.…”

Overuse of Cardiovascular Services

“…Decision support that flags a possible overuse situation and makes preferred, appropriate care the default option for order entry may be effective. 50 In addition, didactic teaching, when combined with an electronic pocket card with AUC tips, individualized e-mail performance feedback, and smartphone application use, may help to improve appropriate referral to cardiac imaging tests. 51,52 Second, price transparency for both providers and patients may help foster a shared sense of stewardship and awareness of at least the immediate costs of testing and treatment.…”