Troponin trumps CK-MB—time to stop double-ordering

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 - Mary Tierney

Innovation in medicine is amazing, adding tests, devices, drugs and procedures to our arsenal all the time. We’re good at adding new options that are better, stronger and faster but often remiss in sunsetting old options. And it’s costing us millions each year in diagnosing acute MI patients as a recent JAMA Internal Medicine article points out.

Case in point: Cardiac troponin replaced Creatine kinase-myocardial band (CK-MB) as the biomarker of choice that has been a staple in ERs for 30 years. With evidence showing troponin is superior in clinical accuracy, it’s time to stop double-ordering. Some facilities have but many more have not.

The study authors estimate about $416 million is spent on cardiac biomarker tests each year, per Medicare data. Eliminating one of the two tests would save both money and reduce physician confusion. It also would improve understanding of the proper use of cTn (cardiac troponin) and reduce potential patient harm, the authors noted.

Step one, they say, is educating healthcare leaders and physicians on the evidence supporting the exclusive use of cardiac troponin. Next comes partnering with IT staff to remove CK-MB from standardized order sets and measuring data preintervention and postintervention, including cases of missed diagnoses, number of tests ordered and cost savings for both patients and hospitals.

If you haven’t already done it, put it on your list.