The widely used biomarker contributes to the hundreds of millions of dollars spent annually on cardiac care, but adds no value in evaluating patients with suspected acute coronary syndrome, researchers say.
The widely used creatine kinase-myocardial band testing provides little value for detecting damaged heart muscles and should be eliminated from clinical settings, according to a paper published this week in JAMA Internal Medicine.
The research also cites studies showing that troponin testing is a more definitive predictor of in-hospital mortality and severity of disease.
The efficacy of CK-MB testing has been called into question since at least the turn of the century.
The report is the first of several peer-reviewed implementation guides co-authored by faculty from the High Value Practice Academic Alliance, a coalition created by The Johns Hopkins University School of Medicine. Faculty from more than 80 academic institutions, representing 15 medical specialties and subspecialties, have joined HVPAA to advance quality-driven value improvement.
“This article is the first in a series of collaborative multi-institutional publications designed to bridge knowledge to high-value practice,” said lead author Jeffrey Trost, MD, an assistant professor of medicine at the Johns Hopkins University School of Medicine.
“We present multiple quality improvement initiatives that safely eliminated CK-MB to give providers reassurance about trusting troponin levels when managing patients with suspected acute coronary syndrome.”
The efficacy of CK-MB testing has been called into question since at least the turn of the century. As recently as 2014, American Heart Association/American College of Cardiology guidelines concluded that CK-MB provides no value for diagnosing heart attacks.
Despite that assessment, Trost said, a 2013 survey conducted by the College of American Pathologists found that 77% of nearly 2,000 labs in the U.S. still use CK-MB as a cardiac damage biomarker. Researchers estimate that all blood tests for diagnosing heart attacks add $416 million each year to the cost of care.
Trost said the JAMA report provides a four-step plan to phase out CK-MB based on the U.S. Health Resources & Services Administration’s quality improvement initiative.
The four steps listed include:
- Design and implement a hospital-wide education campaign.
- Partner with clinical stakeholders in cardiology, emergency medicine, internal medicine, laboratory/pathology to remove CK-MB from standardized heart disease routine order sets.
- Enlist information technology/laboratory medicine staff to create and integrate a best practice “alert” that appears on any computerized provider order entry system when clinicians order CK-MB.
- Measure use of the test and patient care quality and safety outcomes before and after the intervention.
As far back as 2000, the American College of Cardiology and the European Society of Cardiology identified cardiac troponin as the ideal biomarker due to its high sensitivity for detecting injury to the heart.
John Commins is a senior editor at HealthLeaders.