Since late 2021, Lehigh Valley Health Network (LVHN) doctors have been using high-sensitivity troponin (a protein in your bloodstream) testing to assess people with chest pain for heart attacks.

“Within three hours, we can assess a patient, and if results are good, we can release them with the reassurance that there’s nothing going on,” says Richard MacKenzie, MD, Senior Vice Chair, Emergency and Hospital Medicine, LVHN.

High-sensitivity troponin testing

High-sensitivity troponin testing is measured in nanograms per liter. A heart attack damages heart muscle, releasing more troponin when heart muscle cells die. Rising troponin levels can signal a heart attack.

In addition to an electrocardiogram (ECG), high-sensitivity troponin testing is used to determine if a heart attack has occurred or is in progress.

“We can detect even the slightest elevation in the troponin molecule. Importantly, high-sensitivity troponin tests also allow identification of people with a very low risk for a heart attack,” says cardiologist Bruce Feldman, DO, with LVH Cardiology–1250 Cedar Crest and Lehigh Valley Heart and Vascular Institute.

Under the new testing regimen, patients in the emergency room are tested when they arrive and then an hour later.

“Measuring the high-sensitivity troponin level this way also shortens the time for the emergency room physician to decide on discharge versus the additional in-hospital testing,” Dr. Feldman says.

Decisions on whether to discharge or keep a chest pain patient are now typically made within 3-4 hours (instead of 4-12).

According to one study, just one in three hospitals nationwide was using high-sensitivity troponin testing at the end of 2021, a number that is expected to rise.

Dashboard with a special clinical view

At LVHN and Lehigh Valley Heart and Vascular Institute, doctors have a powerful and unique digital dashboard with real-time information on chest pain cases (15,000 a year) across the network.

Among discharged patients with no heart injury and a low risk for a heart attack, Dr. MacKenzie says the dashboard data showed nearly 100% don’t have a major heart-related problem for the next 90 days.

Evolution of chest pain

evaluation

Dr. Feldman has been with LVHN for 37 years and has seen the evolution of chest pain and heart attack care nationally. In late fall 2021, LVHN shifted to high-sensitivity troponin testing, and Dr. Feldman led the effort to educate emergency department doctors, nurses and other clinicians.

“World-class heart care like this is just one more reason why LVHN is the region’s heart care leader, why more people trust LVHN and Lehigh Valley Heart and Vascular Institute,” says Eric Elgin, MD, Chief, Division of Cardiology, Lehigh Valley Heart and Vascular Institute.