{
  "abstract": "Introduction Accurate troponin testing is essential for the timely diagnosis and management of acute coronary syndrome (ACS), a condition associated with significant morbidity and mortality if missed. Troponin is a sensitive biomarker for myocardial injury, with a negative result effectively ruling out acute myocardial infarction (AMI). However, its specificity is lower, sometimes as low as 80%, meaning elevated levels can result from conditions other than AMI, including heart failure, valvular disease, tachycardia, chronic lung disease, renal failure, pneumonia, pulmonary embolism, and atrial fibrillation. Troponin should only be requested when AMI is clinically suspected, not as a screening tool. NICE guidelines advise against using high-sensitivity troponin tests in patients without suspected ACS. 1 Method We conducted a retrospective review at an 800-bed district general hospital to assess the appropriateness of troponin testing. Data were collected from 200 patients over five days in November 2023. Since some patients had repeat tests, a total of 283 troponin results were analysed. Clinical case notes were reviewed to determine the indication for each test, along with presenting symptoms and signs. Each request was assessed by a general medical doctor and validated by a cardiologist.Results Of the 283 high-sensitivity troponin tests, 206 (73%) were ordered for patients with symptoms suggestive of a cardiac cause (e.g., chest pain, dyspnoea, ECG changes). However, 62 (22%) were for non-AMI-related symptoms like cough, fever, falls, collapse, or general malaise—cases where troponin testing was unnecessary. Additionally, 15 (5%) were requested for pleuritic chest pain. This unnecessary testing caused delays in decision-making and prompted further investigations when elevated troponin levels were due to non-cardiac conditions.Each troponin test costs an estimated £5 to £10, including the assay, venepuncture equipment, and staff costs, making inappropriate testing a significant financial burden.2 Our analysis suggests that reducing unnecessary troponin requests could save between £22,000 and £56,000 annually.Conclusion Optimising troponin use is essential for improving diagnostic accuracy, timely ACS management, and minimising unnecessary testing. We recommend refining the emergency department triage process, ensuring troponin tests are primarily requested for patients with chest pain or concerning ECG changes. Clinicians should then reassess and determine whether further testing is needed for atypical presentations. Implementing these measures will improve efficiency, enhance patient care, and generate cost savings.References NICE. Chest pain of recent onset: assessment and diagnosis [Internet]. London: NICE; 2016 [cited 2025 Mar 1]. Available from: https://www.nice.org.uk/guidance/cg95/chapter/Recommendations NICE. High-sensitivity troponin tests for the early rule out of NSTEMI [Internet]. London: NICE; 2022 [cited 2025 Mar 1]. Available from: https://www.nice.org.uk/guidance/dg40/documents/overview",
  "authors": [
    {
      "affiliations": [
        "Stockport NHS Foundation Trust"
      ],
      "name": "Yusif Shakanti"
    },
    {
      "affiliations": [
        "Stockport NHS Foundation Trust"
      ],
      "name": "Omar Mahrous"
    },
    {
      "affiliations": [
        "Stockport NHS Foundation Trust"
      ],
      "name": "David Lai Chin Kon"
    }
  ],
  "title": "2-048 Evaluation of troponin usage against NICE guidelines and the financial impact of inappropriate testing – a retrospective study",
  "uid": "d6b7975d-46ca-53e1-97c6-3764b3e276da"
}