TACIT (High Sensitivity Troponin T Rules Out Acute Cardiac Insufficiency Trial): An Observational Study to Identify Acute Heart Failure Patients at Low Risk for Rehospitalization or Mortality

Peter S. Pang, Gregory J. Fermann, Benton R. Hunter, Phillip D. Levy, Kathleen A. Lane, Xiaochun Li, Mette Cole, Sean P. Collins

Research output: Contribution to journalArticle

2 Scopus citations

Abstract

Background: Identifying low-risk acute heart failure patients safe for discharge from the emergency department is a major unmet need. Methods AND RESULTS: A prospective, observational, multicenter pilot study targeting lower risk acute heart failure patients to determine whether hsTnT (high-sensitivity troponin T) identifies emergency department acute heart failure patients at low risk for rehospitalization and mortality. hsTnT was drawn at baseline and 3 hours. Phone follow-up occurred at 30 and 90 days. The primary end point composite of all-cause mortality, rehospitalization, and emergency department visits at 90 days (changed from 30 days because of lack of mortality events), analyzed using logistic regression. Secondary end points: 30- and 90-day all-cause mortality. hsTnT values less than the 99th percentile were defined as low hsTnT. Out of 527 enrolled patients, 499 comprised the initial analysis set. Of these, 332 had both 0- and 3-hour hsTnT drawn, of whom 319 completed 30 day follow-up. The average age was 62, 60% male, and 57% black. Median hsTnT was 26.4 ng/L (interquartile range, 15.1-44.3). There were 99 (21%) 30-day composite events, 13 (2.7%) deaths at 30 days, and 25 deaths (8.2%) at 90 days. Serial hsTnT values below the 99th percentile were not associated with a lower risk for the 90-day primary composite end point (odds ratio, 0.79; 95% CI, 0.42-1.50; P=0.4736). However, no deaths occurred in the low hsTnT group at 30 days with 1 death at 90 days. Conclusions: hsTnT did not identify patients at low risk for the primary outcome of rehospitalization, emergency department visits, and mortality at 90 days. Clinical Trial Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02592135.

Original languageEnglish (US)
Article numbere005931
JournalCirculation: Heart Failure
Volume12
Issue number7
DOIs
StatePublished - Jul 1 2019

Keywords

  • heart failure
  • hospitalization
  • mortality
  • risk

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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