Bedside troponin testing shortened emergency stays without adding risk

Chest pain is one of the commonest reasons people come to an emergency department, and most of them are not having a heart attack. Sorting the few who are from the many who are not turns on a blood test — cardiac troponin, a protein released when heart muscle is injured — and on how fast the result comes back. A new randomised trial asked a deceptively simple question: if you run that test on a machine at the bedside instead of sending the sample to the central laboratory, do patients get out of the emergency department sooner, and is it safe to do so? The answer to both was yes [s1].

The trial, ICare-FASTER, was published in Circulation and run as a pragmatic, stepped-wedge cluster-randomised trial across six hospital sites [s1]. In a stepped-wedge design, every site starts in the control condition and crosses over to the intervention at a randomly assigned time, so each hospital serves as its own comparison — a pragmatic way to test a change that is rolled out to whole departments rather than individual patients. Between February 2023 and January 2025 the trial captured 59,980 emergency-department presentations from 44,747 individuals, whose mean age was 61 years and of whom 49.5% were female; 31,392 of those presentations fell during the intervention phase [s1].

What the trial compared

Both arms used the same accelerated diagnostic pathway — a single-sample rule-out step designed to discharge low-risk patients quickly. The only difference was where the troponin was measured. The control arm used a central-laboratory high-sensitivity troponin assay; the intervention arm used a whole-blood, high-sensitivity troponin I assay run at the point of care, in the department itself [s1]. The logic is about logistics, not biology: a bedside result is available the moment a clinician looks for it, rather than waiting in a queue for transport, processing and reporting from a distant lab.

The primary effectiveness outcome was emergency-department length of stay, analysed with a generalised linear mixed model that accounts for the clustered design. The safety outcome — the one that matters most — was the rate of myocardial infarction or cardiac death within 30 days, the check on whether faster turnaround was letting real heart attacks slip out the door [s1].

What it found

Moving the test to the bedside shortened stays. After adjustment for factors associated with length of stay, the intervention reduced it by 13% (95% confidence interval 9% to 16%; P<0.001), which corresponded to 47 minutes (95% CI 33 to 61 minutes) off a mean control-arm length of stay of 376 minutes [s1]. In a crowded department, where beds and waiting-room chairs are the binding constraint, shaving roughly three-quarters of an hour off a visit that otherwise runs past six hours is a meaningful gain in flow.

Crucially, speed did not come at the cost of safety. The rate of myocardial infarction or cardiac death within 30 days was identical in the two arms — 0.39% with usual laboratory testing and 0.39% with point-of-care testing (P=0.54) [s1]. That equivalence is the result's backbone: a faster pathway that missed more heart attacks would be worse than a slow one, and here the harder endpoint did not move.

How to read it

This is a positive, pragmatic result, and its design is a large part of why it is persuasive. Because it was embedded in real departments over two years and tested the whole implementation — the device, the workflow and the people using it — rather than an idealised version, it measures what hospitals would actually get. The flip side of pragmatism is that the gain reflects these six sites and their existing pathways; a department already fast at laboratory turnaround has less to gain, and the benefit of any point-of-care device depends on it matching the accuracy of the lab assay it replaces, which this trial's safety data support [s1].

The finding fits a broader push to make the chest-pain pathway quicker without making it more dangerous, alongside work on rapid troponin rule-out protocols and CT coronary angiography for acute chest pain.

What to watch

ICare-FASTER tested length of stay and 30-day safety, not downstream costs, readmissions or how the approach performs outside well-resourced trial sites — the registry record (ACTRN12619001189112) marks it as a completed study, and those economic and real-world questions are the natural next ones [s1][s2]. The wider signal is that where a test is run, not just which test it is, can change how an emergency department functions.

This article describes research and is not medical advice. Chest pain should be assessed by a clinician; anyone with new or severe chest pain should seek emergency care.