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Study: Use of Cardiac Biomarker Testing Too Often Unrelated to Symptoms

October 9th, 2016

DALLAS – Emergency departments need to develop strategies for more appropriate use of cardiac biomarker testing, according to a new study.

The research, published online recently by JAMA Internal Medicine, finds that the tests are used even without common symptoms of acute coronary syndrome (ACS). Study authors from the University of Texas Southwestern Medical Center also point out that cardiac biomarker testing is frequently employed during visits with a high volume of other tests or services independent of the clinical presentation.

The article notes that cardiac biomarker testing is not routinely indicated in the ED because of “low utility and potential downstream harms from false-positive results.” Sensitivity of cardiac biomarkers is low in the first six hours after symptom onset, according to previous research.

For the retrospective study, researchers focused on ED visits by adults selected from the 2009 and 2010 National Hospital Ambulatory Medical Care Survey. The main outcome measured was use of cardiac biomarker testing during the ED visit.

Results indicate that, of 44,448 ED visits, cardiac biomarkers were tested in 16.9% of patients, representing 28.6 million visits. Furthermore, the authors assert, biomarker testing occurred in 8.2% of visits without ACS-related symptoms, representing 8.5 million visits.

For patients eventually admitted, cardiac biomarkers were tested in 47% of all visits, including 35.4% of visits without ACS-related symptoms, according to the study.

Researchers point out that, among all ED visits, the number of other tests or services performed was the strongest predictor of biomarker testing independent of symptoms of ACS.

Compared with 0 to 5 other tests or services performed, more than 10 other tests or services performed was associated with 59.55 times the odds of biomarker testing, the authors report, adding that the adjusted probabilities of biomarker testing if 0 to 5, 6 to 10, or more than 10 other tests or services performed were 6.3%, 34.3%, and 62.3%, respectively.