Troponin is unrelated to outcomes in heart failure patients discharged from the emergency department.

• Type of Material: Article
• Authors: Gregory J Fermann, University of Cincinnati; Jon W Schrock, Metro Health, Cleveland; Phillip D Levy, Wayne State University; Peter Pang, Indiana University School of Medicine Indianapolis Indiana USA.; Javed Butler, Emory University; Annna Marie Chang, Thomas Jefferson University; Douglas Char, Washington University, St. Louis; Deborah Diercks, University of Texas‐Southwestern; Jin H Han, Metro Health, Cleveland; Brian Hiestand, Wake Forest University; Chris Hogan, Virginia Commonwealth University; Cathy A Jenkins, Vanderbilt University; Christy Kampe, Vanderbilt University; Yosef Khan, American Heart Association/American Stroke Association Dallas; Vijaya A Kumar, Wayne State University; Sangil Lee, University of Iowa Iowa City; Joann Lindenfeld, Vanderbilt University Medical Center Nashville Tennessee USA.; Dandan Liu, Vanderbilt University Nashville Tennessee USA.; Karen F Miller, Vanderbilt University Medical Center Nashville Tennessee USA.; Frank W Peacock, Baylor College of Medicine Houston Texas USA.; Carolyn Reilly, Emory University; Chad Robichaux, Emory University; Russell L Rothman, Vanderbilt University; Wesley H Self, Vanderbilt University Medical Center; Adam J Singer, Stony Brook University; Sarah A Sterling, University of Mississippi; Alan B Storrow, Vanderbilt University; William B Stubblefield, Vanderbilt University; Cheryl Walsh, Tennessee Valley Healthcare System; John Wilburn, Wayne State University; Sean P Collins, Vanderbilt University
• Language: English
• Date: 2022-04
• Publisher: WILEY
• Publication Version: Final Published Version
• Copyright Statement: © 2022 The Authors. JACEP Open published by Wiley Periodicals LLC on behalf of American College of Emergency Physicians
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1002/emp2.12695
• Title of Journal or Parent Work: J Am Coll Emerg Physicians Open
• Volume: 3
• Issue: 2
• Start Page: e12695
• End Page: e12695
• Grant/Funding Information: This work was supported through a Patient‐Centered Outcomes Research Institute (PCORI) Award (AD‐1409‐21656).
• Keywords: emergency medicine; readmission; biological markers; quality; transitional care; troponin; acute heart failure
• Research Categories: Health Sciences, Medicine and Surgery

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.