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Original Investigation
January 2015

Use of Cardiac Biomarker Testing in the Emergency Department

Author Affiliations
  • 1Division of General Internal Medicine, UT Southwestern Medical Center, Dallas, Texas
JAMA Intern Med. 2015;175(1):67-75. doi:10.1001/jamainternmed.2014.5830

Importance  Cardiac biomarker testing is not routinely indicated in the emergency department (ED) because of low utility and potential downstream harms from false-positive results. However, current rates of testing are unknown.

Objective  To determine the use of cardiac biomarker testing overall, as well as stratified by disposition status and selected characteristics.

Design, Setting, and Participants  Retrospective study of ED visits by adults (≥18 years old) selected from the 2009 and 2010 National Hospital Ambulatory Medical Care Survey, a probability sample of ED visits in the United States.

Exposures  Selected patient, visit, and ED characteristics.

Main Outcomes and Measures  Receipt of cardiac biomarker testing during the ED visit.

Results  Of 44 448 ED visits, cardiac biomarkers were tested in 16.9% of visits, representing 28.6 million visits. Biomarker testing occurred in 8.2% of visits in the absence of acute coronary syndrome (ACS)–related symptoms, representing 8.5 million visits, almost one-third of all visits with biomarker testing. Among individuals subsequently hospitalized, cardiac biomarkers were tested in 47.0% of all visits. In this group, biomarkers were tested in 35.4% of visits despite the absence of ACS-related symptoms. 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 (95% CI, 39.23-90.40) times the odds of biomarker testing. 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.

Conclusions and Relevance  Cardiac biomarker testing in the ED is common even among those without symptoms suggestive of ACS. Cardiac biomarker testing is also frequently used during visits with a high volume of other tests or services independent of the clinical presentation. More attention is needed to develop strategies for appropriate use of cardiac biomarkers.