{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T09:41:11Z","timestamp":1792402871711,"version":"4.4.0"},"reference-count":39,"publisher":"Ovid Technologies (Wolters Kluwer Health)","license":[{"start":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T00:00:00Z","timestamp":1792368000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Point-of-care high-sensitivity cTn (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 by ensuring that results are consistently available when sought by clinicians. We assessed the real-life effectiveness and safety of implementing point-of-care hs-cTn testing in the ED.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>We conducted a pragmatic, stepped-wedge cluster-randomized trial. The control arm was usual care with an accelerated diagnostic pathway using a single-sample rule-out step with a central laboratory hs-cTn assay. The intervention arm used the same pathway with a point-of-care hs-cTnI assay. The primary effectiveness outcome was ED length of stay assessed using a generalized linear mixed model. The safety outcome was myocardial infarction or cardiac death within 30 days.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      Six sites participated, with 59\u2009980 ED presentations (44\u2009747 individuals; mean 61\u00b119 years of age; 49.5% female) from February 2023 through January 2025; 31\u2009392 presentations were during the intervention arm. After adjustment for covariates associated with length of stay, the intervention reduced length of stay by 13% (95% CI, 9%\u201316%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001), corresponding to a reduction of 47 minutes (95% CI, 33\u201361 minutes) from a mean length of stay in the control arm of 376 minutes. The 30-day myocardial infarction or cardiac death rate was similar in the control and intervention arms (0.39% and 0.39%, respectively;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.54).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>Implementation of whole-blood hs-cTnI testing at the point of care into an accelerated diagnostic pathway was safe and reduced length of stay in the ED compared with laboratory testing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>REGISTRATION:<\/jats:title>\n                    <jats:p>\n                      URL:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.anzctr.org.au\">https:\/\/www.anzctr.org.au<\/jats:ext-link>\n                      ; Unique identifier: ACTRN12619001189112.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circulationaha.126.080866","type":"journal-article","created":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T09:00:16Z","timestamp":1792400416000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["ICare-FASTER (Improving Care by Faster Risk Stratification Through Use of High-Sensitivity Point-of-Care Troponin in Patients Presenting With Possible Acute Coronary Syndrome in the Emergency Department): A Stepped-Wedge Cluster-Randomized Trial"],"prefix":"10.1161","clinical-trial-number":[{"clinical-trial-number":"actrn12619001189112","registry":"10.18810\/anzctr"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9399-5227","authenticated-orcid":true,"given":"Martin","family":"Than","sequence":"first","affiliation":[{"name":"Christchurch Heart Institute, Department of Medicine (M.T., A.M.R, R.T.), New Zealand."},{"name":"Department of Emergency Medicine, University of Kansas Medical Center, Kansas City (M.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9475-0344","authenticated-orcid":true,"given":"John W.","family":"Pickering","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8113-3814","authenticated-orcid":true,"given":"Laura R.","family":"Joyce","sequence":"additional","affiliation":[{"name":"Department of Surgery and Critical Care (L.R.J.), New Zealand."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vanessa","family":"Buchan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0924-818X","authenticated-orcid":true,"given":"Christopher M.","family":"Florkowski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0533-7991","authenticated-orcid":true,"given":"Nicholas L.","family":"Mills","sequence":"additional","affiliation":[{"name":"BHF Centre for Cardiovascular Science, University of Edinburgh, UK (N.L.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8829-9224","authenticated-orcid":true,"given":"Laura","family":"Hamill","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason","family":"Prystowsky","sequence":"additional","affiliation":[{"name":"Emergency Department, Gisborne Hospital, Tairawhiti, New Zealand (J.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-0239-5906","authenticated-orcid":true,"given":"Simon","family":"Harger","sequence":"additional","affiliation":[{"name":"Emergency Department, Hawke\u2019s Bay Hospital, Hastings, New Zealand (S.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary","family":"Reed","sequence":"additional","affiliation":[{"name":"Emergency Department, Rotorua Hospital, New Zealand (M.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jared","family":"Bayless","sequence":"additional","affiliation":[{"name":"Emergency Department, Taupo Hospital, New Zealand (J.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Feberwee","sequence":"additional","affiliation":[{"name":"Emergency Department, Ashburton Hospital, New Zealand (A.F.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-8453-8956","authenticated-orcid":true,"given":"Tamsin","family":"Attenburrow","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy","family":"Norman","sequence":"additional","affiliation":[{"name":"Emergency Care Service\u2013Rural (T.N.), Christchurch, New Zealand."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oliver","family":"Welfare","sequence":"additional","affiliation":[{"name":"Queensland Health, Gold Coast, Australia (O.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamika","family":"Heiden","sequence":"additional","affiliation":[{"name":"Research Impact Academy, Melbourne, Victoria, Australia (T.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4576-4744","authenticated-orcid":true,"given":"Peter","family":"Kavsak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1183-3959","authenticated-orcid":true,"given":"Allan S.","family":"Jaffe","sequence":"additional","affiliation":[{"name":"Departments of Cardiology and Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN (A.S.J.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5920-6498","authenticated-orcid":true,"given":"Fred S.","family":"Apple","sequence":"additional","affiliation":[{"name":"Departments of Laboratory Medicine and Pathology, Hennepin Healthcare\/HCMC and University of Minnesota, Minneapolis (F.S.A.)."},{"name":"Hennepin Healthcare Research Institute, Minneapolis, MN (F.S.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2730-6742","authenticated-orcid":true,"given":"W. Frank","family":"Peacock","sequence":"additional","affiliation":[{"name":"Emergency Department, Baylor College of Medicine, Houston, TX (W.F.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6611-8229","authenticated-orcid":true,"given":"Louise","family":"Cullen","sequence":"additional","affiliation":[{"name":"Emergency and Trauma Centre, Royal Brisbane and Women\u2019s Hospital, Brisbane, Australia (L.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sally","family":"Aldous","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2023-8177","authenticated-orcid":true,"given":"A. Mark","family":"Richards","sequence":"additional","affiliation":[{"name":"Christchurch Heart Institute, Department of Medicine (M.T., A.M.R, R.T.), New Zealand."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cameron","family":"Lacey","sequence":"additional","affiliation":[{"name":"Health New Zealand (C.L.), Christchurch, New Zealand."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7484-4036","authenticated-orcid":true,"given":"Richard","family":"Troughton","sequence":"additional","affiliation":[{"name":"Christchurch Heart Institute, Department of Medicine (M.T., A.M.R, R.T.), New Zealand."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Frampton","sequence":"additional","affiliation":[{"name":"University of Otago Christchurch (C.F.), New Zealand."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9089-8130","authenticated-orcid":true,"given":"Richard","family":"Body","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Science, The University of Manchester, UK (R.B.)."},{"name":"Emergency Department, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, UK (R.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1120-6405","authenticated-orcid":true,"given":"Christian","family":"M\u00fceller","sequence":"additional","affiliation":[{"name":"Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, Switzerland (C.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2763-5949","authenticated-orcid":true,"given":"Sarah","family":"Lord","sequence":"additional","affiliation":[{"name":"National Health and Medical Research Council (NHMRC) Clinical Trials Centre, The University of Sydney, Australia (S.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9100-3466","authenticated-orcid":true,"given":"Peter M.","family":"George","sequence":"additional","affiliation":[{"name":"Austin Pathology, Austin Hospital, Heidelberg, Victoria, Australia (P.M.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-6545-6724","authenticated-orcid":true,"given":"Gerard","family":"Devlin","sequence":"additional","affiliation":[{"name":"Gisborne Hospital, Tairawhiti, New Zealand (G.D.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"on behalf of the ICare-FASTER Investigation Team","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,10,19]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"crossref","unstructured":"Cairns C Kang K. National Hospital Ambulatory Medical Care Survey: 2022 Emergency Department Summary Tables. Published 2023. https:\/\/www.cdc.gov\/nchs\/data\/nhamcs\/web_tables\/2022-nhamcs-ed-web-tables.pdf","DOI":"10.15620\/cdc:115748"},{"key":"e_1_3_3_3_2","unstructured":"NICE: National Institute for Health and Care Excellence. Emergency and acute medical care in over 16s: service delivery and organisation. Published March 28 2018. https:\/\/www.nice.org.uk\/guidance\/ng94"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2019.05.003"},{"key":"e_1_3_3_5_2","unstructured":"International Federation for Emergency Medicine. Report from the Emergency Department Crowding and Access Block Task Force. Published June 2020. https:\/\/assets.nationbuilder.com\/ifem\/pages\/270\/attachments\/original\/1650595379\/ED-Crowding-and-Access-Block-Report-Final-June-30-2020.pdf?1650595379"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2012.02.035"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hlc.2016.06.789"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2021.07.053"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehad191"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.120.052380"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2023-083752"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2013.11362"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2016.01.001"},{"key":"e_1_3_3_14_2","first-page":"27","article-title":"Reducing patient risk and enhancing care through the development and implementation of a new chest pain pathway, expedited by and for the COVID-19 era.","volume":"32","author":"Than M","year":"2021","unstructured":"Than M, Pickering J, Adamson P, Clendon T, Florkowski C, Lainchbury J, Loubser J, Nankivel A, Aldous S. Reducing patient risk and enhancing care through the development and implementation of a new chest pain pathway, expedited by and for the COVID-19 era. EJIFCC. 2021;32:27.","journal-title":"EJIFCC"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1515\/cclm-2024-0312"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1136\/emermed-2023-213689"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.117.031984"},{"key":"e_1_3_3_18_2","unstructured":"R Core Team. R: A language and environment for statistical computing. Published 2026."},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.18637\/jss.v067.i01"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12874-019-0815-8"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.k1614"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.i6795"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(18)30664-0"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2025.03.005"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1111\/1742-6723.70041"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.3390\/jcm14103456"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehae343"},{"key":"e_1_3_3_28_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.122.061148"},{"key":"e_1_3_3_29_2","doi-asserted-by":"publisher","DOI":"10.7326\/M16-1600"},{"key":"e_1_3_3_30_2","doi-asserted-by":"publisher","DOI":"10.1093\/ehjacc\/zuae114"},{"key":"e_1_3_3_31_2","doi-asserted-by":"publisher","DOI":"10.1093\/clinchem\/hvad185"},{"key":"e_1_3_3_32_2","doi-asserted-by":"publisher","DOI":"10.1093\/clinchem\/hvae059"},{"key":"e_1_3_3_33_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2021.01.046"},{"key":"e_1_3_3_34_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13063-015-0838-3"},{"key":"e_1_3_3_35_2","doi-asserted-by":"publisher","DOI":"10.1002\/sim.7348"},{"key":"e_1_3_3_36_2","doi-asserted-by":"publisher","DOI":"10.1177\/0962280220932962"},{"key":"e_1_3_3_37_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0271027"},{"key":"e_1_3_3_38_2","doi-asserted-by":"publisher","DOI":"10.1111\/1742-6723.12566"},{"key":"e_1_3_3_39_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2024.09.033"},{"key":"e_1_3_3_40_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2025.05.005"}],"container-title":["Circulation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/CIRCULATIONAHA.126.080866","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T09:00:18Z","timestamp":1792400418000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCULATIONAHA.126.080866"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,19]]},"references-count":39,"alternative-id":["10.1161\/CIRCULATIONAHA.126.080866"],"URL":"https:\/\/doi.org\/10.1161\/circulationaha.126.080866","relation":{},"ISSN":["0009-7322","1524-4539"],"issn-type":[{"value":"0009-7322","type":"print"},{"value":"1524-4539","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,19]]},"assertion":[{"value":"2026-04-19","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-12","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-19","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"CIRCULATIONAHA.126.080866"}}