Using the HVPAA blueprint to eliminate Creatine Kinase–Myocardial Band Testing at a teaching hospital

From the 2019 HVPAA National Conference

Dr. Haakon Lindekliev (University Hospital of North Norway), Dr. Einar Bugge (University Hospital of North Norway), Ms. Lisbeth Hansen (University Hospital of North Norway)

Background

Cardiac biomarkers are used to diagnose myocardial injury and infarction. Creatinine kinase-myocardial band (CK-MB) has traditionally been the preferred cardiac biomarker. Since the 2000 American College of Cardiology and European Society of Cardiology redefinition of acute myocardial infarction, troponin has replaced CK-MB as the cardiac biomarker of choice. Nevertheless, physicians in many hospitals routinely order both CK-MB and troponin. Faculty from the High Value Practice Academic Alliance (HVPAA) published in 2017 a blueprint for eliminating CK-MB (JAMA Intern Med. 2017;177(10):1508-1512).

After previous unsuccessful attempts to eliminate CK-MB at our hospital, we used the HVPAA blueprint in 2019.

Objective

To describe our experiences with using the HVPAA blueprint to eliminate CK-MB at a teaching hospital

Methods

Based on the HVPAA blueprint, we designed a hospital-wide educational campaign and discussed evidence for removing CK-MB with our patient partnership and experience group, clinical leaders, at morning meetings for cardiologists and for cardiac surgeons, and at a meeting for all hospital staff. Information about troponin and CK-MB was provided to all doctors at our hospital. We removed CK-MB from routine order sets. We followed the number of TnT and CK-MB tests ordered, as well as incidence of adverse events after the intervention.

Results

One week after implementation, we observed a 75% decrease in CK-MB orders. This reduction was stable four months after implementation. Removal of CK-MB did not contribute to any adverse events or failure to diagnose myocardial infarction at four months follow-up. Our experience (including failures) from the implementation will be presented at the conference, and provide an opportunity for discussing how we can further reduce the ordering of CK-MB.

Conclusions

The HVPAA blueprint provides a valuable tool for reducing CK-MB testing.

Clinical Implications

As CK-MB testing provides no incremental value to care in addition to troponin, elimination of CK-MB reduces healthcare cost.

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