Implementation of rapid rule out of myocardial infarction using high-sensitivity troponin: cross-sectional survey of English hospitals

Objectives: Recent guidance recommended use of high-sensitivity troponin for rapid rule out of myocardial infarction (MI) in the English health service. We aimed to determine the extent of implementation of this guidance across English hospitals.

Methods: This study conducted a cross-sectional questionnaire survey of 131 English acute hospitals with over 10 000 admissions per year.

Results: We received 125/131 responses (95%), with 110/125 (88%) reporting use of a high-sensitivity troponin assay and responses showing progressive implementation over the last 10 years. High-sensitivity troponin was reported to be used for rapid rule out of MI in 92/110 Trusts (84%). Review of guidelines received from 95/110 Trusts identified that 71/95 (75%) provided guidance for rapid MI rule out with high-sensitivity troponin: 57 recommended testing at 0 and 3 hours, 4 recommended testing at 0 and 2 hours, and 9 recommended testing at 0 and 1 hour, and timing was unclear at one Trust.

Conclusions: English acute hospital Trusts report widespread implementation of high-sensitivity troponin for rapid rule out of MI, with most recommending testing at 0 and 3 hours.