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Repercussions from Indiscriminate Use of Cardiac Troponin for Intensive Care Patients

Published:December 25, 2020DOI:https://doi.org/10.1016/j.amjms.2020.12.017
      For a multitude of reasons, including concern for patient outcomes, limited self-efficacy, and distress about professional liability, many clinicians are apprehensive about diagnosing and managing cardiovascular disease. This apprehension drives substantial demand for consultation with teams of cardiovascular professionals in the inpatient and outpatient setting. In this issue of the Journal, Kousa et al report on a cohort of patients receiving intensive care with elevated cardiac troponin (Tn) and without evidence of acute coronary syndrome.

      Kousa O, Essa A, Saleh M, et al. The impact of cardiology consultation on medical intensive care unit patients with elevated troponin levels [In press]. 2020. Published online September 7, 2020.

      They found that most patients received a cardiology consultation that was associated with more testing and no difference in short-term or long-term mortality. Their findings suggest that routine cardiology consultation for such patients may not be a high value exercise.
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      References

      1. Kousa O, Essa A, Saleh M, et al. The impact of cardiology consultation on medical intensive care unit patients with elevated troponin levels [In press]. 2020. Published online September 7, 2020.

        • Ganguli I
        • Simpkin AL
        • Lupo C
        • et al.
        Cascades of care after incidental findings in a US National Survey of Physicians.
        JAMA Netw Open. 2019; 2e1913325
      2. Januzzi JL. Troponin and BNP Use in COVID-19.https://www.acc.org/latest-in-cardiology/articles/2020/03/18/15/25/troponin-and-bnp-use-in-covid19. Accessed September 14, 2020.

      3. Sandoval Y, Jaffe AS. Key Points About Myocardial Injury and Cardiac Troponin in COVID-19.https://www.acc.org/latest-in-cardiology/articles/2020/07/17/08/00/key-points-about-myocardial-injury-and-cardiac-troponin-in-covid-19. Accessed September 14, 2020.

        • Hinton J
        • Mariathas M
        • Grocott MP
        • Curzen N
        High sensitivity troponin measurement in critical care: Flattering to deceive or ‘never means nothing’?.
        J Intensiv Care Soc. 2020; 21: 232-240
        • Lim W
        • Qushmaq I
        • Devereaux PJ
        • et al.
        Elevated cardiac troponin measurements in critically ill patients.
        Arch Intern Med. 2006; 166: 2446-2454
        • Wang G
        • Wang J
        • Wu S
        • et al.
        Clinical impact of using a more sensitive troponin assay in patients with acute chest pain.
        Clin Cardiol. 2019; 42: 561-567
        • Zachoval CF
        • Dolscheid-Pommerich R
        • Graeff I
        • et al.
        High-sensitivity troponin T testing: consequences on daily clinical practice and effects on diagnosis of myocardial infarction.
        J Clin Med. 2020; 9: 775
        • DeFilippis AP
        • Chapman AR
        • Mills NL
        • et al.
        Assessment and Treatment of Patients With Type 2 myocardial infarction and acute nonischemic myocardial injury.
        Circulation. 2019; 140: 1661-1678
      4. Critical Care Societies Collaborative. Choosing Wisely. https://www.choosingwisely.org/clinician-lists/#parentSociety=Critical_Care_Societies_Collaborative. Accessed September 17, 2020.