Rates of Echocardiography, Coronary Angiography, and Coronary Intervention Associated With Troponin Testing in Hospitalized Patients.

Diagnosis of acute myocardial infarction (AMI) often depends on detection of cardiac troponin elevation >99th percentile. However, troponin elevation is commonly found in patients without AMI. We have previously reported an association between troponin elevation and rates of electrocardiogram (ECG), echocardiography (ECHO), and coronary angiography (CAG) in patients with a primary diagnosis of sepsis. We hypothesized that elevated troponin might be associated with greater use of ECHO and CAG in primary diagnoses other than sepsis and that this correlation might also include percutaneous coronary intervention (PCI). We reviewed all inpatient admissions to nine hospitals in Texas in 2016 collecting primary International Statistical Classification of Diseases and Related Health Problems (International Classification of Diseases-10) diagnoses, troponin test data, and the presence of ECHO, CAG, or PCI during hospitalization. We identified 56,895 unique inpatient admissions, of which 14,326 (25.2%) were associated with troponin testing. Of patients tested, 26.1% had one or more troponin I values ≥0.1 ng/ml (99th percentile). Primary ICD-10 diagnoses were grouped into (1) AMI, (2) primary diagnosis other than AMI (non-AMI), (3) congestive heart failure (CHF), (4) sepsis, and (5) Other excluding AMI, CHF, or sepsis. Troponin testing was itself associated with greater utilization of ECHO, CAG, and PCI in all groups except CHF. Troponin I values ≥0.1 ng/ml were associated with increased rates of ECHO, CAG, and PCI across all groups.

Description of a Method to Obtain Complete One-Year Follow-Up in the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry.

The Centers for Medicare and Medicaid Services National Coverage Determination requires centers performing transcatheter aortic valve implantation (TAVI) to report clinical outcomes up to 1 year. Many sites encounter challenges in obtaining complete 1-year follow-up. We report our process to address this challenge. A multidisciplinary process involving clinical personnel, data and quality managers, and research coordinators was initiated to collect TAVI data at baseline, 30 days, and 1 year. This process included (1) planned clinical follow-up of all patients at 30 days and 1 year; (2) query of health-care system-wide integrated data warehouse (IDW) to ascertain last date of clinical contact within the system for all patients; (3) online obituary search, cross-referencing for unique patient identifiers to determine if mortality occurred in remaining unknown patients; and (4) phone calls to remaining unknown patients or patients' families. Between January 2012 and December 2016, 744 patients underwent TAVI. All 744 patients were eligible for 30-day follow-up and 546 were eligible for 1-year follow-up. At routine clinical follow-up of 22 of 744 (3%) patients at 30 days and 180 of 546 (33%) patients at 1 year had unknown survival status. The integrated data warehouse query confirmed status-alive for an additional 1 of 22 patients at 30 days (55%) and 91 of 180 patients at 1 year (51%). Obituaries were identified for 23 of 180 additional patients at 1 year (13%). Phone contact identified the remaining unknown patients at 30 days and 1 year, resulting in 100% known survival status for patients at 30 days (744 of 744) and at 1 year (546 of 546). In conclusion, using a comprehensive approach, we were able to determine survival status in 100% of patients who underwent TAVI.