Background: There are well-described sex differences in the utilization of invasive procedures and outcomes for patients with suspected acute myocardial infarction (AMI). Cardiac troponin testing currently is instrumental in the diagnosis of AMI, but the factors that affect troponin testing variations are currently unknown. We sought to investigate whether there is an association between sex and variations in troponin utilization in the Veterans Health Administration.
Methods: We developed a database of Veterans that included all Veterans with a reported troponin result from 2012-2016 across 130 VA facilities. We then linked each troponin result with patient, provider, and facility-level factors including patient demographics, death date, location of troponin testing, facility-level complexity, and troponin reference range. We then performed a multivariate logistic regression to compare the odds of a male having an abnormal troponin result as compared to a female.
Results: Our cohort included 1,192,575 Veterans of which 7.7% were female with the mean age 67. Of the 195,153 patients with an abnormal troponin result, 189,767 (97.2%) were male and 5,386 (2.8%) were female. The median percentage of abnormal troponin results across VA facilities was 17 (interquartile range[IQR]: 8-29%) for males, and the median was 8% (IQR: 4-14%) for females (Figure). After multivariate adjustment, we found that men were significantly more likely to have an abnormal troponin result than women (OR: 1.50 95%, CI [1.41-1.58]).
Conclusion: There is significant variation in the utilization of troponin testing across VA facilities. Our findings suggests that a patient’s sex may help explain the variation in troponin utilization. Further studies should explore whether sex differences in troponin testing account for discrepancies in outcomes and procedure utilization for patients with AMI.