Use of cardiac biomarker testing in the emergency department

JAMA Intern Med. 2015 Jan;175(1):67-75. doi: 10.1001/jamainternmed.2014.5830.


Importance: Cardiac biomarker testing is not routinely indicated in the emergency department (ED) because of low utility and potential downstream harms from false-positive results. However, current rates of testing are unknown.

Objective: To determine the use of cardiac biomarker testing overall, as well as stratified by disposition status and selected characteristics.

Design, setting, and participants: Retrospective study of ED visits by adults (≥18 years old) selected from the 2009 and 2010 National Hospital Ambulatory Medical Care Survey, a probability sample of ED visits in the United States.

Exposures: Selected patient, visit, and ED characteristics.

Main outcomes and measures: Receipt of cardiac biomarker testing during the ED visit.

Results: Of 44,448 ED visits, cardiac biomarkers were tested in 16.9% of visits, representing 28.6 million visits. Biomarker testing occurred in 8.2% of visits in the absence of acute coronary syndrome (ACS)-related symptoms, representing 8.5 million visits, almost one-third of all visits with biomarker testing. Among individuals subsequently hospitalized, cardiac biomarkers were tested in 47.0% of all visits. In this group, biomarkers were tested in 35.4% of visits despite the absence of ACS-related symptoms. Among all ED visits, the number of other tests or services performed was the strongest predictor of biomarker testing independent of symptoms of ACS. Compared with 0 to 5 other tests or services performed, more than 10 other tests or services performed was associated with 59.55 (95% CI, 39.23-90.40) times the odds of biomarker testing. The adjusted probabilities of biomarker testing if 0 to 5, 6 to 10, or more than 10 other tests or services performed were 6.3%, 34.3%, and 62.3%, respectively.

Conclusions and relevance: Cardiac biomarker testing in the ED is common even among those without symptoms suggestive of ACS. Cardiac biomarker testing is also frequently used during visits with a high volume of other tests or services independent of the clinical presentation. More attention is needed to develop strategies for appropriate use of cardiac biomarkers.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Ambulatory Care / statistics & numerical data*
  • Biomarkers / analysis*
  • Cardiovascular Diseases / diagnosis*
  • Diagnostic Tests, Routine / statistics & numerical data*
  • Emergency Service, Hospital / statistics & numerical data*
  • Female
  • Health Care Surveys
  • Humans
  • Male
  • Middle Aged
  • Young Adult


  • Biomarkers