Patterns of Use of Cardiac Troponins Amongst Clinicians within Public Sector Health Care Facilities in KwaZulu-Natal, South Africa

Original Article Patterns of Use of Cardiac Troponins Amongst Clinicians within Public Sector Health Care Facilities in KwaZulu-Natal, South Africa Evette L. Subramoney 1,2, Ashandree Reddy 1,2 and Verena Gounden 1,2,3,* 1 Department of Chemical Pathology, National Health Laboratory Service, Inkosi Albert Luthuli Central Hospital, Durban 4001, South Africa 2 Department of Chemical Pathology, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban 4001, South Africa 3 Department of Clinical Biochemistry, University Hospital Galway, Newcastle Road, H91YR71 Galway, Ireland * Correspondence: [email protected] Received: 19 January 2025; Accepted: 30 January 2025; Published: 1 March 2025 Abstract: Background: The data evaluating troponin utilisation and requesting practices in comparison to best practice guidelines is limited in developing and middle-income countries. This study aimed to assess the ordering practices of high sensitivity cardiac troponins amongst clinicians within public sector health care facilities in KwaZulu-Natal (KZN), South Africa. Methods: Requisition details and results of all cardiac troponin (cTn) requests for individuals older than 18 years analysed by the National Health Laboratory Services (NHLS) across KZN during the period 1 January 2018 to 31 December 2019 were extracted from the NHLS Central Data Warehouse. Time interval between the baseline and consecutive measurement was calculated for those who underwent serial sampling and delta troponin (percent change) determined for those samples with time interval <3 hours. Each cTn request was also assessed for concomitant requests for other cardiac biomarkers. Results: 75% of all cTn requests were analysed using a high-sensitivity assay. A serial sampling strategy (18.6%) was only observed in hospital settings with a relatively similar frequency amongst emergency departments, high care and general wards. Only 3.5% of samples represented serial samples collected within 3 h of each other. Moreover, 69% of all cTn requests had an associated request for other cardiac biomarkers, whilst 65% of CKMB requests did not have an associated cTn request. Conclusion: Awareness and adherence to clinical guidelines for the evaluation of chest pain is essential to reduce the variability of requesting practice for troponin assays.