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2009 HSR&D National Meeting Abstract

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National Meeting 2009

1064 — Outcomes for Inpatients with Abnormal Troponin

Sinnott PL (VA Health Economics Resource Center, Menlo Park, CA), Holmstrom ST (VA Health Economics Resource Center, Menlo Park, CA), Larsen GC (VA Medical Center Oregon Health Sciences University, Portland, OR), Johnson G (VA Cooperative Studies Program, West Haven, CT), McFalls EO (VA Medical Center, University of Minnesota, Minneapolis, MN)

Objectives:
Patients with an abnormal Troponin (cTn) lab result and acute coronary syndrome (ACS) benefit from early intervention, however, no guidelines exist for patients with an abnormal cTn but without an ACS diagnosis (non-ACS). Clinicians hypothesized that non-ACS patients with abnormal cTn have worse outcomes than patients identified as having an ACS. In preparation for a study of early intervention for these patients we sought to: determine if the VA lab results file (LAR) could be used to identify a population of patients at risk; and compare 365-day outcomes for patients admitted to the hospital with abnormal cTn lab results.

Methods:
Using the VA LAR we identified all patients admitted in FY2006 with cTn results reported during an inpatient stay. We categorized the first admission as ACS or non-ACS using ICD-9 diagnoses. We defined the peak cTn result during the reference hospitalization as abnormal or not using the VA External Peer Review Program (EPRP) cut-offs. We linked utilization, discharge, and death data for 12 months following the reference admission, excluding data for those patients who died during the hospitalization, were discharged to a nursing home or hospice, or had a length of stay > 30 days.

Results:
In FY2006, a cTn result was reported for 95,840 hospitalized patients who lived through the index hospitalization. 21,668 patients (22.6%) had an abnormal cTn level and 77,279 had a non-ACS diagnosis (80.6%). Of those with a non-ACS condition, 16.05% had an abnormal peak cTn result. Non-ACS patients with an abnormal cTn result had greater risk of death within 365 days post-hospitalization (OR 1.639: 95% CI 1.564-1.718) and greater risk of death if they did not receive a cardiac diagnostic intervention (OR 2.345: 95% CI 2.061-2.670) compared to those with a normal cTn.

Implications:
Patients admitted to the hospital with an abnormal cTn result and a non-ACS diagnosis had higher risks of death following the reference hospitalization, and higher risk of death if they did not receive diagnostic procedures.

Impacts:
These preliminary results suggest that further studies are needed to understand this high-risk population with abnormal cTn and non-ACS.


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