Trends in Troponin-Only Testing for AMI in Academic Teaching Hospitals and the Impact of Choosing Wisely®

J Hosp Med. 2017 Dec;12(12):957-962. doi: 10.12788/jhm.2846. Epub 2017 Sep 20.


Background: Identifying hospitals that are both early and consistent adopters of high-value care can help shed light on the culture and practices at those institutions that are necessary to promote high-value care nationwide. The use of troponin to diagnose acute myocardial infarction (AMI), and not to test for myoglobin or creatine kinase-MB (CK-MB), is a high-value recommendation of the Choosing Wisely® campaign.

Objective: To examine the variation in cardiac biomarker testing and the effect of the Choosing Wisely® troponin-only recommendation for the diagnosis of AMI.

Design: A retrospective observational study using administrative ordering data from Vizient's Clinical Database/Resource Manager.

Setting: Ninety-one academic medical centers from the fourth quarter of 2013 through the third quarter of 2016.

Patients: Hospitalized patients with a principal discharge diagnosis of AMI.

Intervention: The Choosing Wisely® recommendation to order troponin-only testing to diagnose AMI was released during the first quarter of 2015.

Results: In 19 hospitals, troponin-only testing was consistently ordered to diagnose AMI before the Choosing Wisely® recommendation and throughout the study period. In 34 hospitals, both troponin and myoglobin/CK-MB were ordered to diagnose AMI even after the Choosing Wisely® recommendation. In 26 hospitals with low rates of troponin-only testing before the Choosing Wisely® recommendation, the release of the recommendation was associated with a statistically significant increase in the rate of troponin-only testing to diagnose AMI.

Conclusions: In institutions with low rates of troponin-only testing prior to the Choosing Wisely® recommendation, the recommendation was associated with a significant increase in the rate of troponin-only testing.

Publication types

  • Observational Study
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Biomarkers / blood
  • Biomarkers / metabolism
  • Guideline Adherence
  • Hospitals, Teaching / statistics & numerical data
  • Hospitals, Teaching / trends*
  • Humans
  • Myocardial Infarction / diagnosis*
  • Quality Indicators, Health Care
  • Retrospective Studies
  • Time Factors
  • Troponin / blood
  • Troponin / metabolism*


  • Biomarkers
  • Troponin