The usage patterns of cardiac bedside markers employing point-of-care testing for troponin in non-ST-segment elevation acute coronary syndrome: results from CRUSADE.
BACKGROUND
Point-of-care (POC) testing may expedite the care of emergency department (ED) patients suspected of having acute coronary syndromes (ACS). We evaluated the use patterns of cardiac bedside markers or POC testing for troponin in patients with non-ST-segment elevation (NSTE) ACS.


METHODS
NSTE ACS data were collected from the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the American College of Cardiology/American Heart Association (ACC/AHA) Guidelines (CRUSADE) registry. We compared hospital and patient characteristics, in-hospital events, and process-of-care variables between hospitals to those that did not use POC testing in > or = 50% of enrolled patients. We examined characteristics, in-hospital events, and process-of-care differences between patients with negative vs positive troponin POC testing results.


RESULTS
Of 568 hospitals, 74 (16,276 patients) had high POC usage compared with 197 hospitals (50,782 patients) with no troponin POC usage. From the high POC usage hospitals, 12,604 patients had recorded troponin POC test results. Hospitals with high POC usage had a shorter ED length of stay and were less likely to administer aspirin, beta-blockers, and heparin during the first 24 hours of care. Patients with positive troponin POC results were more often older, minority, female, Medicare-insured, diabetic, and renally impaired. They had fewer electrocardiograms within 10 minutes but were more likely to get aspirin, beta-blockers, glycoprotein IIb/IIIa inhibitors, and heparin within 24 hours of arrival. They also had longer ED lengths of stay, received fewer in-hospital and interventional procedures, and had more adverse clinical events.


CONCLUSIONS
Differences existed in how hospitals used POC testing and the care given based on those results. Positive POC results are associated with expedited and higher use of anti-ischemic therapies.
Takakuwa
Kevin M
KM
Thomas Jefferson University Hospital, Philadelphia, Pennsylvania 19107, USA. Kevin.Takakuwa@jefferson.edu
Ou
Fang-Shu
FS
Peterson
Eric D
ED
Pollack
Charles V
CV
Peacock
W Frank
WF
Hoekstra
James W
JW
Ohman
E Magnus
EM
Gibler
W Brian
WB
Blomkalns
Andra L
AL
Roe
Matthew T
MT
D054058:Acute Coronary Syndrome / Q000097:blood / Q000175:diagnosis* / Q000628:therapy; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data; D015415:Biomarkers / Q000097:blood; D002317:Cardiovascular Agents / Q000627:therapeutic use; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data; D004562:Electrocardiography / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D019095:Point-of-Care Systems / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D012042:Registries; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014336:Troponin / Q000097:blood*; D014481:United States
D015415:Biomarkers; D002317:Cardiovascular Agents; D014336:Troponin