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Background: Cardiac troponin is a sensitive marker of myocardial necrosis and is used throughout Veterans Affairs (VA) facilities to identify Veterans who are having an acute coronary syndrome (ACS). However, underutilization of troponin testing can lead to underdiagnoses of ACS while inappropriate overutilization of troponin testing may result in unnecessary hospital admissions, stress testing, and invasive procedures. Variations in troponin utilization may contribute to differences in the care of Veterans with suspected ACS, but the degree of variations in troponin utilization is unclear.Methods: We created a cohort of Veterans that included all patients with a troponin result from 2012-2016 extracted from VHA data. Patients with an uninterpretable result were excluded. We calculated for each VA facility the percentage of abnormal troponin results and then compared the percentage of abnormal troponins across facilities.Results: Our cohort consisted of 1,192,575 Veterans from 130 VA facilities who met inclusion for our criteria with an associated 4,383,938 number of troponin results. Overall, 848,340 (19.4%) troponin results were abnormal from 195,153 patients (16.4%). There was large variation across VHA sites, ranging from less than 0.6% to 42.7%, in the rates of abnormal troponin results [Figure].Conclusions: There is substantial variation across facilities in the variation of abnormal troponin results. We aim to utilize this data to study additional facility-level, clinician-level, and patient-level factors that may be contributing to this variation. Future findings may allow us to identify interventions that can improve quality of care in the workup of acute coronary syndrome across VA facilities.