Patient Care

Troponin Leak Portends Poorer Outcomes in Congestive Heart Disease Hospitalizations


Clinical question: What is the association between detectable cardiac troponin (cTn) levels and outcomes in persons hospitalized with acute decompensated heart failure (ADHF)?

Background: There are millions of ADHF hospitalizations per year, and all-cause mortality and readmission rates are high. Efforts to better risk-stratify such patients have included measuring cTn levels and determining risk of increased length of stay, hospital readmission, and mortality.

Study design: Systematic review and meta-analysis.

Setting: Twenty-six observational cohort studies.

Synopsis: Compared with an undetectable cTn, detectable or elevated cTn levels were associated with greater length of stay (odds ratio [OR], 1.05; 95% CI, 1.01¬–1.10) and greater in-hospital death (OR, 2.57; 95% CI, 2.27–2.91). ADHF patients with detectable or elevated cTn were also at increased risk for mortality and composite of mortality and readmission over the short, intermediate, and long term. Reviewers eventually considered the overall association of a detectable or elevated troponin with mortality and readmission as moderate (relative association measure >2.0).

Meanwhile, few studies in this analysis showed a continuous and graded relationship between cTn levels and clinical outcomes.

Limitations of the review include arbitrarily stratifying groups by the level of cTn from assays whose lower limit of detection vary. The authors also admit the various associations are likely affected by several confounders for which they could not adjust because individual participant data were unavailable.

Finally, while acknowledging patients with chronic stable heart failure often have baseline elevated cTn levels, accounting for this in the analysis was limited.

Bottom line: A detectable or elevated level of cTn during ADHF hospitalization leads to worse outcomes both during and after discharge.

Citation: Yousufuddin M, Abdalrhim AD, Wang Z, Murad MH. Cardiac troponin in patients hospitalized with acute decompensated heart failure: a systematic review and meta-analysis [published online ahead of print February 18, 2016]. J Hosp Med. doi:10.1002/jhm.2558.

Recommended Reading

Long-Term Mortality Benefits With Coronary Artery Bypass Grafting for Ischemic Cardiomyopathy
The Hospitalist
Prior clopidogrel tied to more events in medically treated ACS patients
The Hospitalist
Higher Risk of Cataracts After Percutaneous Coronary Intervention
The Hospitalist
Study Finds: Blood Pressure Medication and Stain Cholesterol Fighter Decreases the Risk of Heart Attack and Stroke in Patients with Hypertension and Moderate Risk of Heart Disease
The Hospitalist
Heart Disease Rates Have Dropped but Vary Widely by Region
The Hospitalist
No Mortality Benefit to Cardiac Catheterization in Patients with Stable Ischemic Heart Disease
The Hospitalist
Study Suggests Growing Up in a Stress-Free Environment Lowers your Risk of Heart Attacks
The Hospitalist
Questions Have Been Raised about Potential Risks from Using Abbott Laboratories' Novel Coronary Stent
The Hospitalist
New Clinical Guides Available on Anemia, Congestive Heart Failure
The Hospitalist
CRT in Patients with Heart Failure Without LBBB May Harm
The Hospitalist
   Comments ()