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Research review recommends eliminating widely ordered blood test for diagnosing heart attacks

Researchers at the Johns Hopkins University School of Medicine and the Mayo Clinic have compiled peer-reviewed evidence and crafted a guideline designed to help physicians and medical centers stop the use of a widely ordered blood test that adds no value in evaluating patients with suspected heart attack.

The investigators’ report on the test, published in JAMA Internal Medicine, points to a previous statement from the American College of Cardiology and five peer-reviewed studies concluding that creatine kinase-myocardial band (CK-MB) testing can no longer be considered an effective biomarker for detecting damaged heart muscle and can be safely eliminated from practice in this clinical setting.

The new report is the first in a series of peer-reviewed implementation guides co-authored by faculty from the High Value Practice Academic Alliance (HVPAA), a national 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 and are working together 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. 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,” says Jeffrey Trost, M.D., assistant professor of medicine at the Johns Hopkins University School of Medicine and the paper’s corresponding author.

Heart disease remains the leading cause of death in men and women in the United States, and each year 735,000 Americans have heart attacks that damage the heart muscle, according to the U.S. Centers for Disease Control and Prevention. Of those, an estimated 120,000 die. About one in five heart attacks are “silent,” yielding no symptoms, but symptoms such as chest tightness or pain, dizziness, nausea and fatigue are good reasons to seek immediate evaluation, according to the American Heart Association.