Point-of-care high-sensitivity troponin I shortens ED stays for possible acute coronary syndromePoint-of-care testing cuts emergency room stays by 47 minutes for heart patients

medRxiv Published April 24, 2026 Study authors: Than, M.; Pickering, J. W.; Joyce, L. R.; Buchan, V. A.; Florkowski, C. M.; Mills, N. L.; Hamill, L.… DOI ↗ Editorial oversight: Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

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Key Takeaway

Consider POC hs-cTnI to reduce ED length of stay without increasing 30-day MI or cardiac death.

This stepped-wedge cluster randomized trial evaluated point-of-care high-sensitivity troponin I (POC hs-cTnI) testing within an accelerated diagnostic pathway for possible acute coronary syndrome. Conducted across six emergency departments, the study included 44,747 individuals (mean age 61±19 years, 49.5% female) and 59,980 ED presentations. The comparator was usual care using a single-sample rule-out step with central laboratory hs-cTn assay. The primary outcome was ED length of stay; secondary outcomes included 30-day MI or cardiac death over 30 days of follow-up.

ED length of stay was reduced by 13% (47 minutes; 95% CI, 9 to 16%; 47 minutes, 95% CI, 33 to 61 minutes; P<0.001) with POC hs-cTnI. The mean length of stay in the control arm was 376 minutes. Thirty-day MI or cardiac death was 0.39% in both control and intervention arms (P=0.54), indicating no difference in safety outcomes.

Adverse events, serious adverse events, discontinuations, and overall tolerability were not reported. The authors concluded that implementing whole-blood POC hs-cTnI testing in an accelerated pathway was safe and reduced ED length of stay compared with laboratory testing.

Key limitations include the stepped-wedge design, which may allow for contamination across sites, and the absence of detailed safety data. Generalizability may be affected by local workflows and assay performance. Clinicians should consider these results as supportive of implementation while confirming that local processes and patient populations align with the study setting.

Waiting in an emergency department for hours can be stressful, especially when you suspect a heart problem. A large study involving nearly 45,000 people over 61 years old found a way to speed things up safely. By using a point-of-care test that checks for heart damage markers right at the bedside, doctors could rule out heart attacks much faster than with standard lab methods. This change helped patients leave the hospital 47 minutes sooner on average. The study looked at nearly 60,000 visits across six different emergency departments. It compared this new fast testing method against the usual care, which still used a quick rule-out step but relied on a central laboratory for the final check. The results were clear: the new testing method did not cause any harm or increase the risk of heart attacks or death within 30 days. Rates of these serious events were identical in both groups. This approach offers a practical way to help older adults get answers and go home faster without compromising their safety.

What this means for you:

Point-of-care heart tests in the ER safely cut wait times by 47 minutes.

Study Details

Study typeRct

EvidenceLevel 2

PublishedApr 2026

View Original Abstract ↓

BACKGROUND Point-of-care (POC) high-sensitivity cardiac troponin (hs-cTn) testing has the potential to expedite decision-making and reduce emergency department (ED) length of stay for patients presenting with possible myocardial infarction (MI) by ensuring that results are consistently available when looked for by clinicians. We assessed the real-life effectiveness and safety of implementing POC hs-cTn testing in the ED. METHODS We conducted a pragmatic, stepped-wedge cluster randomized trial. The control arm was usual care with an accelerated diagnostic pathway utilizing a single-sample rule-out step with a central laboratory hs-cTn assay. The intervention arm used the same pathway with a POC hs-cTnI. The primary effectiveness outcome was ED length of stay assessed using a generalized linear mixed model, and the safety outcome was 30-day MI or cardiac death. RESULTS Six sites participated with 59,980 ED presentations (44,747 individuals, 61{+/-}19 years, 49.5% female) from February 2023 to January 2025, in which 31,392 presentations were during the intervention arm. After adjustment for co-variates associated with length of stay, the intervention reduced length of stay by 13% (95% confidence intervals [CI], 9 to 16%. P<0.001), corresponding to a reduction of 47 minutes (95%CI, 33 to 61 minutes) from a mean length of stay in the control arm of 376 minutes. The 30-day MI or cardiac death rate was similar in the control and intervention arms (0.39% and 0.39% respectively, P=0.54). CONCLUSIONS Implementation of whole-blood hs-cTnI testing at the POC into an accelerated diagnostic pathway was safe and reduced length of stay in the ED compared with laboratory testing.

Point-of-care high-sensitivity troponin I shortens ED stays for possible acute coronary syndromePoint-of-care testing cuts emergency room stays by 47 minutes for heart patients

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Point-of-care high-sensitivity troponin I shortens ED stays for possible acute coronary syndromePoint-of-care testing cuts emergency room stays by 47 minutes for heart patients

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