Cardiology · Internal Medicine · 1 h ago
Point-of-care troponin testing shortened emergency department stays in trial
A stepped-wedge cluster-randomized trial across six emergency departments found that point-of-care high-sensitivity troponin testing reduced length of stay for patients presenting with possible acute coronary syndrome. Thirty-day myocardial infarction or cardiac death rates were similar with point-of-care and laboratory testing.
- Six-site trial included 59,980 emergency department presentations.
- Point-of-care testing reduced adjusted length of stay by 47 minutes.
- Thirty-day MI or cardiac death rates were 0.39% in both groups.
The pragmatic stepped-wedge cluster-randomized ICare-FASTER trial compared usual care with an accelerated diagnostic pathway using central-laboratory high-sensitivity cardiac troponin (hs-cTn) testing against the same pathway using point-of-care hs-cTnI. Six sites contributed 59,980 emergency department presentations from 44,747 people between February 2023 and January 2025; mean age was 61 years, and 49.5% were female. The primary effectiveness outcome was emergency department length of stay, and the safety outcome was myocardial infarction or cardiac death within 30 days.
There were 31,392 presentations during the intervention period. After adjustment, point-of-care testing was associated with a 13% reduction in length of stay (95% CI, 9%–16%), equivalent to 47 minutes (95% CI, 33–61 minutes) from a control-arm mean of 376 minutes. The 30-day rate of myocardial infarction or cardiac death was 0.39% in both groups (P=0.54).
The findings suggest that point-of-care hs-cTnI can speed emergency department decision-making within this accelerated pathway without an observed increase in the measured 30-day safety outcome. Applicability depends on local implementation and use of the studied pathway; the abstract does not provide further detail on site characteristics or subgroup results.
In practice
For adults presenting to emergency departments with possible acute coronary syndrome, the trial supports the potential for point-of-care hs-cTnI testing within an accelerated diagnostic pathway to shorten emergency department stays. Across six sites and nearly 60,000 presentations, adjusted length of stay fell by 47 minutes, while 30-day myocardial infarction or cardiac death rates were 0.39% in both groups. This is evidence for the tested implementation and pathway; the abstract does not establish applicability to other assays, settings, or protocols.
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Circulation: ICare-FASTER (Improving Care by Faster Risk Stratification Through Use of High-Sensitivity Point-of-Care Troponin in Patients Presenting With Possible Acute Coronary Syndrome in the Emergency Department): A Stepped-Wedge Cluster-Randomized Trial ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.