Abstract Body (Do not enter title and authors here): HYPOTHESIS AND PURPOSE: Delayed availability of high-sensitivity cardiac troponin (hs-cTn) results can limit timely decision-making in patients with suspected acute myocardial infarction (AMI). A point-of-care (POC) hs-cTnI assay delivering results in under 10 minutes may reduce emergency department (ED) length of stay (LOS). This study aimed to assess the effectiveness and safety of implementing POC hs-cTnI testing in multiple EDs, replacing laboratory-based hs-cTn assays.
DESIGN AND METHODS: A pragmatic, stepped-wedge cluster randomised trial.This has been published (doi 10.1136/bmjopen-2023-083752) and registered (ACTRN12619001189112).
SAMPLE SIZE: 59,980 ED presentations (44,747 individuals) from February 2023 to January 2025), with 31,392 presentations during POC hs-cTnI implementation
POPULATION STUDIED: Adult (aged ≥18 years) who received at least one hs-cTn test in the ED at six hospitals.
INTERVENTIONS:The control arm was usual care, with patients assessed by an accelerated diagnostic pathway using laboratory hs-cTn assays and which included a single-troponin low-risk rule-out decision step. In the intervention arm, the Siemens Atellica VTLi POC hs-cTnI test became the default troponin test for most ED patients. Laboratory cTn could be used in patients thought likely to be admitted and needing further in-patient cTn testing. The first hospital to receive the intervention for 4 months was designated the sentinel hospital, and implementation learnings regarding of POC-hs-cTnI were used to support implementation at the other hospitals. Other sites were randomised to begin implementation 1 month apart. The intervention phase was a minimum 5 months in each hospital. A run-in phase (2 to 4 months) between the control and intervention arms occured during which training was completed, and the POC-cTnI introduced into clinical practice.
POWER CALCULATIONS: At an α of 0.05 and power of 90% 5,785 presentations were required for a clinically meaningful ≥15 minute reduction in LOS effect size
PRIMARY ENDPOINTS: ED length of stay
SECONDARY ENDPOINTS: MACE within 30d of patients discharged directly from ED between the control and intervention arms
MAIN RESULTS: LOS was reduced by the intervention by 13% (95%CI: 9% to 16%), corresponding to 47 minutes (95%CI: 33 to 45 minutes) from the mean of 376 minutes in the control arm. There was no evidence of a change in the MACE rate, 0.24% (control) and 0.24% (intervention), p=0.96.