Health

Alarming Trends in Cardiac Biomarker Testing in U.S. Emergency Departments: A Call for Change

2025-01-28

Author: Daniel

Recent analyses from U.S. emergency departments (EDs) highlight a concerning inconsistency in the use of cardiac biomarker testing, particularly troponin, when diagnosing Acute Coronary Syndrome (ACS). The findings indicate that many patients are being tested despite a lack of typical symptoms, including chest pain, suggesting the need for a reevaluation of testing practices.

Between 2014 and 2022, approximately 7% of ED patients had their troponin or creatine kinase-MB levels measured, regardless of their presenting symptoms, as revealed in a research letter led by Cian McCarthy, MB, BCh, from Massachusetts General Hospital and Harvard Medical School. Alarmingly, around two-thirds of these patients did not report chest pain, and fewer than 2% of them were diagnosed with ACS. This raises an important concern: the potential harms of testing may outweigh the benefits in this group.

Cian McCarthy emphasized the delicate balancing act faced by medical professionals: “On one hand, we don’t want to risk missing cases of myocardial infarction. However, overtesting can lead to complications, including unnecessary hospitalization due to prolonged ED stays, overcrowding, and invasive procedures that carry their own risks.”

Even among patients presenting with chest pain, the rates of cardiac biomarker testing are surprisingly low—only 25.6% of these patients were evaluated. McCarthy posits that this indicates a dangerous possibility of under-testing those who may actually need it, while simultaneously calling attention to the over-testing of patients without chest pain.

The data, derived from the National Hospital Ambulatory Medical Care Survey, included an impressive total of 97,085 ED visits, translating to nearly 732 million visits nationally over the span of eight years. It is noteworthy that while there was a slight increase in cardiac biomarker testing at the onset of the COVID-19 pandemic, the overall trend remained stable, with no significant changes detected throughout the study period.

The research underscores a lack of clarity regarding the rationale behind testing. For example, among patients without obvious heart-related symptoms, various factors influenced testing decisions. Abnormal vital signs, such as hypotension, significantly increased the likelihood of receiving cardiac biomarker tests, as did demographic factors like race and existing health conditions.

Interestingly, while the diagnosis of ACS was recorded in 2.8% of patients who did not undergo cardiac biomarker testing, the rate was notably higher (5.6%) among those presenting with chest pain. This variation in diagnosis rates highlights the potential shortcomings in current testing protocols.

As researchers noted, they were unable to delve deeper into the specifics of cardiac biomarker data or discern the appropriateness of the tests conducted or the subsequent diagnoses made. McCarthy and his team suggest that refining testing strategies is paramount to enhancing the diagnosis of ACS and improving patient outcomes.

However, the path to improvement remains complex. McCarthy proposed that employing machine learning techniques could revolutionize the way patient data—including demographics and pre-existing health conditions—guides the assessment for ACS risk, ultimately optimizing the use of cardiac biomarker testing.

The implications of these findings are significant for the future of emergency medicine and patient care. As the healthcare system grapples with the dual pressures of ensuring accurate diagnoses while avoiding unnecessary testing, stakeholders must urgently address these inconsistencies. This could lead to a more streamlined and effective approach to cardiac care, ultimately saving lives and resources.

As trials and studies continue to evolve, this is one headline worth keeping an eye on. Are U.S. emergency departments at a crossroads? The future of cardiac testing could hinge on these insights!