Troponin is unrelated to outcomes in heart failure patients discharged from the emergency department
Abstract Background Prior data has demonstrated increased mortality in hospitalized patients with acute heart failure (AHF) and troponin elevation. No data has specifically examined the prognostic significance of troponin elevation in patients with AHF discharged after emergency department (ED) mana...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2022-04-01
|
| Series: | Journal of the American College of Emergency Physicians Open |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/emp2.12695 |
| _version_ | 1828399832263294976 |
|---|---|
| author | Gregory J. Fermann Jon W. Schrock Phillip D. Levy Peter Pang Javed Butler Anna Marie Chang Douglas Char Deborah Diercks Jin H. Han Brian Hiestand Chris Hogan Cathy A. Jenkins Christy Kampe Yosef Khan Vijaya A. Kumar Sangil Lee JoAnn Lindenfeld Dandan Liu Karen F. Miller W. Frank Peacock Carolyn M. Reilly Chad Robichaux Russell L. Rothman Wesley H. Self Adam J. Singer Sarah A. Sterling Alan B. Storrow William B. Stubblefield Cheryl Walsh John Wilburn Sean P. Collins |
| author_facet | Gregory J. Fermann Jon W. Schrock Phillip D. Levy Peter Pang Javed Butler Anna Marie Chang Douglas Char Deborah Diercks Jin H. Han Brian Hiestand Chris Hogan Cathy A. Jenkins Christy Kampe Yosef Khan Vijaya A. Kumar Sangil Lee JoAnn Lindenfeld Dandan Liu Karen F. Miller W. Frank Peacock Carolyn M. Reilly Chad Robichaux Russell L. Rothman Wesley H. Self Adam J. Singer Sarah A. Sterling Alan B. Storrow William B. Stubblefield Cheryl Walsh John Wilburn Sean P. Collins |
| author_sort | Gregory J. Fermann |
| collection | DOAJ |
| description | Abstract Background Prior data has demonstrated increased mortality in hospitalized patients with acute heart failure (AHF) and troponin elevation. No data has specifically examined the prognostic significance of troponin elevation in patients with AHF discharged after emergency department (ED) management. Objective Evaluate the relationship between troponin elevation and outcomes in patients with AHF who are treated and released from the ED. Methods This was a secondary analysis of the Get with the Guidelines to Reduce Disparities in AHF Patients Discharged from the ED (GUIDED‐HF) trial, a randomized, controlled trial of ED patients with AHF who were discharged. Patients with elevated conventional troponin not due to acute coronary syndrome (ACS) were included. Our primary outcome was a composite endpoint: time to 30‐day cardiovascular death and/or heart failure‐related events. Results Of the 491 subjects included in the GUIDED‐HF trial, 418 had troponin measured during the ED evaluation and 66 (16%) had troponin values above the 99th percentile. Median age was 63 years (interquartile range, 54‐70), 62% (n = 261) were male, 63% (n = 265) were Black, and 16% (n = 67) experienced our primary outcome. There were no differences in our primary outcome between those with and without troponin elevation (12/66, 18.1% vs 55/352, 15.6%; P = 0.60). This effect was maintained regardless of assignment to usual care or the intervention arm. In multivariable regression analysis, there was no association between our primary outcome and elevated troponin (hazard ratio, 1.00; 95% confidence interval, 0.49–2.01, P = 0.994) Conclusion If confirmed in a larger cohort, these findings may facilitate safe ED discharge for a group of patients with AHF without ACS when an elevated troponin is the primary reason for admission. |
| first_indexed | 2024-12-10T09:23:12Z |
| format | Article |
| id | doaj.art-8bda082e60d04cfa8ed0378f5922f1f1 |
| institution | Directory Open Access Journal |
| issn | 2688-1152 |
| language | English |
| last_indexed | 2024-12-10T09:23:12Z |
| publishDate | 2022-04-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American College of Emergency Physicians Open |
| spelling | doaj.art-8bda082e60d04cfa8ed0378f5922f1f12022-12-22T01:54:38ZengWileyJournal of the American College of Emergency Physicians Open2688-11522022-04-0132n/an/a10.1002/emp2.12695Troponin is unrelated to outcomes in heart failure patients discharged from the emergency departmentGregory J. Fermann0Jon W. Schrock1Phillip D. Levy2Peter Pang3Javed Butler4Anna Marie Chang5Douglas Char6Deborah Diercks7Jin H. Han8Brian Hiestand9Chris Hogan10Cathy A. Jenkins11Christy Kampe12Yosef Khan13Vijaya A. Kumar14Sangil Lee15JoAnn Lindenfeld16Dandan Liu17Karen F. Miller18W. Frank Peacock19Carolyn M. Reilly20Chad Robichaux21Russell L. Rothman22Wesley H. Self23Adam J. Singer24Sarah A. Sterling25Alan B. Storrow26William B. Stubblefield27Cheryl Walsh28John Wilburn29Sean P. Collins30Department of Emergency Medicine University of Cincinnati Cincinnati Ohio USADepartment of Emergency Medicine Metro Health Cleveland Ohio USADepartment of Emergency Medicine Wayne State University Detroit Michigan USADepartment of Emergency Medicine Indiana University School of Medicine Indianapolis Indiana USADivision of Cardiovascular Medicine Stony Brook University Stony Brook New York USADepartment of Emergency Medicine Thomas Jefferson University Philadelphia Pennsylvania USADivision of Emergency Medicine Washington University St. Louis Missouri USADepartment of Emergency Medicine University of Texas‐Southwestern Dallas Texas USADepartment of Emergency Medicine Vanderbilt University Medical Center Nashville Tennessee USADepartment of Emergency Medicine Wake Forest University Winston‐Salem North Carolina USADepartment of Emergency Medicine Virginia Commonwealth University Richmond Virginia USADepartment of Emergency Medicine Vanderbilt University Medical Center Nashville Tennessee USADepartment of Biostatistics Vanderbilt University Nashville Tennessee USAAmerican Heart Association/American Stroke Association Dallas Texas USADepartment of Emergency Medicine Wayne State University Detroit Michigan USADepartment of Emergency Medicine University of Iowa Iowa City Iowa USADivision of Cardiovascular Disease Vanderbilt University Medical Center Nashville Tennessee USADepartment of Biostatistics Vanderbilt University Nashville Tennessee USADepartment of Emergency Medicine Vanderbilt University Medical Center Nashville Tennessee USADepartment of Emergency Medicine Baylor College of Medicine Houston Texas USADepartment of Emergency Medicine Emory University Atlanta Georgia USADepartment of Medicine Emory University School of Medicine Atlanta Georgia USADepartment of Internal Medicine Pediatrics & Health Policy Vanderbilt University Nashville Tennessee USADepartment of Emergency Medicine Vanderbilt University Medical Center Nashville Tennessee USADepartment of Emergency Medicine Renaissance School of Medicine at Stony Brook University Stony Brook New York USADepartment of Emergency Medicine University of Mississippi Medical Center Jackson Mississippi USADepartment of Emergency Medicine Vanderbilt University Medical Center Nashville Tennessee USADepartment of Emergency Medicine Vanderbilt University Medical Center Nashville Tennessee USAGeriatric Research Education and Clinical Center Tennessee Valley Healthcare System Nashville Tennessee USADepartment of Emergency Medicine Wayne State University Detroit Michigan USADepartment of Emergency Medicine Vanderbilt University Medical Center Nashville Tennessee USAAbstract Background Prior data has demonstrated increased mortality in hospitalized patients with acute heart failure (AHF) and troponin elevation. No data has specifically examined the prognostic significance of troponin elevation in patients with AHF discharged after emergency department (ED) management. Objective Evaluate the relationship between troponin elevation and outcomes in patients with AHF who are treated and released from the ED. Methods This was a secondary analysis of the Get with the Guidelines to Reduce Disparities in AHF Patients Discharged from the ED (GUIDED‐HF) trial, a randomized, controlled trial of ED patients with AHF who were discharged. Patients with elevated conventional troponin not due to acute coronary syndrome (ACS) were included. Our primary outcome was a composite endpoint: time to 30‐day cardiovascular death and/or heart failure‐related events. Results Of the 491 subjects included in the GUIDED‐HF trial, 418 had troponin measured during the ED evaluation and 66 (16%) had troponin values above the 99th percentile. Median age was 63 years (interquartile range, 54‐70), 62% (n = 261) were male, 63% (n = 265) were Black, and 16% (n = 67) experienced our primary outcome. There were no differences in our primary outcome between those with and without troponin elevation (12/66, 18.1% vs 55/352, 15.6%; P = 0.60). This effect was maintained regardless of assignment to usual care or the intervention arm. In multivariable regression analysis, there was no association between our primary outcome and elevated troponin (hazard ratio, 1.00; 95% confidence interval, 0.49–2.01, P = 0.994) Conclusion If confirmed in a larger cohort, these findings may facilitate safe ED discharge for a group of patients with AHF without ACS when an elevated troponin is the primary reason for admission.https://doi.org/10.1002/emp2.12695acute heart failurebiological markersemergency medicinequalityreadmissiontransitional care |
| spellingShingle | Gregory J. Fermann Jon W. Schrock Phillip D. Levy Peter Pang Javed Butler Anna Marie Chang Douglas Char Deborah Diercks Jin H. Han Brian Hiestand Chris Hogan Cathy A. Jenkins Christy Kampe Yosef Khan Vijaya A. Kumar Sangil Lee JoAnn Lindenfeld Dandan Liu Karen F. Miller W. Frank Peacock Carolyn M. Reilly Chad Robichaux Russell L. Rothman Wesley H. Self Adam J. Singer Sarah A. Sterling Alan B. Storrow William B. Stubblefield Cheryl Walsh John Wilburn Sean P. Collins Troponin is unrelated to outcomes in heart failure patients discharged from the emergency department Journal of the American College of Emergency Physicians Open acute heart failure biological markers emergency medicine quality readmission transitional care |
| title | Troponin is unrelated to outcomes in heart failure patients discharged from the emergency department |
| title_full | Troponin is unrelated to outcomes in heart failure patients discharged from the emergency department |
| title_fullStr | Troponin is unrelated to outcomes in heart failure patients discharged from the emergency department |
| title_full_unstemmed | Troponin is unrelated to outcomes in heart failure patients discharged from the emergency department |
| title_short | Troponin is unrelated to outcomes in heart failure patients discharged from the emergency department |
| title_sort | troponin is unrelated to outcomes in heart failure patients discharged from the emergency department |
| topic | acute heart failure biological markers emergency medicine quality readmission transitional care |
| url | https://doi.org/10.1002/emp2.12695 |
| work_keys_str_mv | AT gregoryjfermann troponinisunrelatedtooutcomesinheartfailurepatientsdischargedfromtheemergencydepartment AT jonwschrock troponinisunrelatedtooutcomesinheartfailurepatientsdischargedfromtheemergencydepartment AT phillipdlevy troponinisunrelatedtooutcomesinheartfailurepatientsdischargedfromtheemergencydepartment AT peterpang troponinisunrelatedtooutcomesinheartfailurepatientsdischargedfromtheemergencydepartment AT javedbutler troponinisunrelatedtooutcomesinheartfailurepatientsdischargedfromtheemergencydepartment AT annamariechang troponinisunrelatedtooutcomesinheartfailurepatientsdischargedfromtheemergencydepartment AT douglaschar troponinisunrelatedtooutcomesinheartfailurepatientsdischargedfromtheemergencydepartment AT deborahdiercks troponinisunrelatedtooutcomesinheartfailurepatientsdischargedfromtheemergencydepartment AT jinhhan troponinisunrelatedtooutcomesinheartfailurepatientsdischargedfromtheemergencydepartment AT brianhiestand troponinisunrelatedtooutcomesinheartfailurepatientsdischargedfromtheemergencydepartment AT chrishogan troponinisunrelatedtooutcomesinheartfailurepatientsdischargedfromtheemergencydepartment AT cathyajenkins troponinisunrelatedtooutcomesinheartfailurepatientsdischargedfromtheemergencydepartment AT christykampe troponinisunrelatedtooutcomesinheartfailurepatientsdischargedfromtheemergencydepartment AT yosefkhan troponinisunrelatedtooutcomesinheartfailurepatientsdischargedfromtheemergencydepartment AT vijayaakumar troponinisunrelatedtooutcomesinheartfailurepatientsdischargedfromtheemergencydepartment AT sangillee troponinisunrelatedtooutcomesinheartfailurepatientsdischargedfromtheemergencydepartment AT joannlindenfeld troponinisunrelatedtooutcomesinheartfailurepatientsdischargedfromtheemergencydepartment AT dandanliu troponinisunrelatedtooutcomesinheartfailurepatientsdischargedfromtheemergencydepartment AT karenfmiller troponinisunrelatedtooutcomesinheartfailurepatientsdischargedfromtheemergencydepartment AT wfrankpeacock troponinisunrelatedtooutcomesinheartfailurepatientsdischargedfromtheemergencydepartment AT carolynmreilly troponinisunrelatedtooutcomesinheartfailurepatientsdischargedfromtheemergencydepartment AT chadrobichaux troponinisunrelatedtooutcomesinheartfailurepatientsdischargedfromtheemergencydepartment AT russelllrothman troponinisunrelatedtooutcomesinheartfailurepatientsdischargedfromtheemergencydepartment AT wesleyhself troponinisunrelatedtooutcomesinheartfailurepatientsdischargedfromtheemergencydepartment AT adamjsinger troponinisunrelatedtooutcomesinheartfailurepatientsdischargedfromtheemergencydepartment AT sarahasterling troponinisunrelatedtooutcomesinheartfailurepatientsdischargedfromtheemergencydepartment AT alanbstorrow troponinisunrelatedtooutcomesinheartfailurepatientsdischargedfromtheemergencydepartment AT williambstubblefield troponinisunrelatedtooutcomesinheartfailurepatientsdischargedfromtheemergencydepartment AT cherylwalsh troponinisunrelatedtooutcomesinheartfailurepatientsdischargedfromtheemergencydepartment AT johnwilburn troponinisunrelatedtooutcomesinheartfailurepatientsdischargedfromtheemergencydepartment AT seanpcollins troponinisunrelatedtooutcomesinheartfailurepatientsdischargedfromtheemergencydepartment |