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Johns Hopkins, Mayo Researchers Publish Guide to Phase Out Heart Attack Test

NEW YORK (360Dx) – Researchers from Johns Hopkins University School of Medicine and the Mayo Clinic today published a blueprint outlining the elimination from clinical practice of a popular test for diagnosing heart attacks.

In an article published online in JAMA Internal Medicine, the scientists pointed to steps that institutions should take to phase out creatine kinase-myocardial band testing, or CK-MB, as a diagnostic tool for evaluating patients suspected of having or having had a heart attack. They argued that several peer-reviewed studies strongly suggest that CK-MB "provides no incremental value to patient care, and its elimination can lead to millions of healthcare dollars saved without adversely affecting patient care."

Despite the evidence pointing to the ineffectiveness of CK-MB testing, it remains widely used in US clinical pathology labs and emergency departments, the researchers said, citing a 2013 survey by the College of American Pathologists that found 1,558 out of 1,995, or 77 percent, of national labs in the US still use the test. Furthermore, in 2014, American Heart Association/American College of Cardiology guidelines concluded that CK-MB testing "provides no additional diagnostic value for diagnosing heart attacks," Johns Hopkins said in a statement.

Instead of the CK-MB test, the researcher said, cardiac troponin tests are far more effective for detecting injury to the heart with higher sensitivity for acute myocardial infarction and higher specificity. The continued use of CK-MB testing, they said, can be attributed to the reluctance of clinicians to rely on troponin testing "in certain clinical situations, as well as clinical familiarity."

If CK-MB testing persists, the effect on healthcare costs could be substantial. The researchers estimated that all blood tests for diagnosing heart attacks add $416 million each year to the cost of care.

They outline four steps to phase out the test, including designing and implementing a hospital-wide education program; partnering with clinical stakeholders to remove CK-MB testing from standardized heart disease routine testing orders; enlisting information technology and laboratory medicine staff to create and integrate a best practice "alert" that will appear on computerized provider order entry systems when a CK-MB test is ordered; and measuring the use of the test and patient care quality and safety outcomes before and after the intervention.

The researchers said the blueprint is the first step "to finally putting the CK-MB laboratory test to rest," and acknowledged that there will be pushback to getting rid of the test. "[I]n this case, the biggest hurdle has been convincing physicians who have ordered CK-MB for years to change their practice."

The report is the first of several planned by the High Value Practice Academic Alliance, a national coalition created by Johns Hopkins and made up of faculty from more than 80 academic institutions. Other guidelines from HVPAA will address topics including reducing unnecessary transfusions; routine daily lab tests; antibiotics for asymptomatic bacteriuria; inappropriate C. difficile testing; and cardiac telemetry, Johns Hopkins said.