Effect of transitioning from conventional cardiac troponin to high-sensitivity cardiac troponin on resource utilization- a single center experience.

BACKGROUND: Compared to conventional cardiac troponin (cTn), the high-sensitivity cardiac troponin (hs-cTn) assay is associated with improved detection of myocardial infarction (MI). METHODS: We performed a descriptive retrospective analysis of resource utilization at Rush University Medical Center over the transition period (July 1, 2021) from a cTn to a hs-cTn assay. Inclusion criteria included emergency department (ED) encounters between January 1 to December 31, 2021, with chief complaints of "chest pain" or "dyspnea" with associated troponin orders. The primary endpoint was the percentage of ED discharges. Secondary endpoints included the number of cardiac studies ordered. Univariable comparisons of these endpoints were performed using Student's t-test for continuous variables and Chi-square tests for binary/categorical variables. RESULTS: A total of 5113 encounters were analyzed. Hs-cTn was associated with an overall increase in ED patient discharges with negative troponin tests (44.1% vs. 29.9%, P < 0.01). In terms of cardiac testing per encounter, hs-cTn was associated with significant increases in the number of troponin tests (1.9 vs. 1.6, P < 0.01), electrocardiograms (3.0 vs. 2.9, P = 0.01), and echocardiograms (0.5 vs. 0.4, P < 0.01). There was a significant decrease in the utilization of stress testing (0.21 vs. 0.26, P < 0.01). There was a significant increase in total coronary angiography use during the hs-cTn period compared to cTn (227/2471 (9.2%) vs. 195/2642 (7.4%), P = 0.02). CONCLUSION: Transitioning from cTn to hs-cTn was associated with significantly increased ED discharges and an increase in troponin tests, ECG, echocardiograms, and coronary angiograms. There was a decrease in the number of stress tests.

Use of a Percutaneous Right Ventricular Assist Device to Manage Right Ventricular Failure in Inferior STEMIs.

Acute right heart failure is a complication of inferior ST-elevation myocardial infarctions. Given the further hemodynamic instability that results from right-sided failure, a treatment option is needed to help bridge toward cardiac recovery. We present a case of using a right ventricular assist device in a patient who had marked improvement in cardiac function after an instance of acute right heart failure.

Joint Families and Cancer Diagnosis in Rural India

Background: Each year, there are over a million new cases of cancer in India, which causes many untimely deaths and increases the economic burden to households. By focusing on preventative measures and finding socioeconomic and behavioral contributors to cancer, steps can be taken to help alleviate this burden. This study aims to find the effect living in a joint family can have on being diagnosed with cancer in rural India. Methods: The study estimates the effect living in a joint family, along with other demographic information, has on being diagnosed with cancer using a logit estimation model. The data for the study was collected from a survey was conducted on the households of the Handiganur village (N=251) comprising of several demographic, social, and medical questions. Results: The study found that living in a joint family lowers the odds of having cancer. The results indicate that living in a joint family reduces the probability of being diagnosed by 7.23 percentage points and is significant at a 5% level. Furthermore, among the other tested variables, eating habit is negatively significant at 5% level, suggesting that if a person eats 3 to 4 times a day his or her likelihood of suffering from cancer will be lowered by 6.55 percentage points. Access to public wells and drinking alcohol both increase the likelihood of being diagnosed with cancer by 7.90 (p<0.1) percentage points and 11.90 (p<0.05) percentage points respectively. Conclusions: The negative effect of joint family could be due to two possible reasons. The first is that there is in fact a biological reason. The second reason for this result could be a false negative, as it could be because people in joint families are not getting the necessary check-ups required to diagnose cancer.