Background: The data evaluating troponin utilisation and requesting practices in comparison to best practice guidelines is limited in developing and middle-income countries. This study aimed to assess the ordering practices of high sensitivity cardiac troponins amongst clinicians within public sector health care facilities in KwaZulu-Natal (KZN), South Africa. Methods: Requisition details and results of all cardiac troponin (cTn) requests for individuals older than 18 years analysed by the National Health Laboratory Services (NHLS) across KZN during the period 1 January 2018 to 31 December 2019 were extracted from the NHLS Central Data Warehouse. Time interval between the baseline and consecutive measurement was calculated for those who underwent serial sampling and delta troponin (percent change) determined for those samples with time interval <3 hours. Each cTn request was also assessed for concomitant requests for other cardiac biomarkers. Results: 75% of all cTn requests were analysed using a high-sensitivity assay. A serial sampling strategy (18.6%) was only observed in hospital settings with a relatively similar frequency amongst emergency departments, high care and general wards. Only 3.5% of samples represented serial samples collected within 3 h of each other. Moreover, 69% of all cTn requests had an associated request for other cardiac biomarkers, whilst 65% of CKMB requests did not have an associated cTn request. Conclusion: Awareness and adherence to clinical guidelines for the evaluation of chest pain is essential to reduce the variability of requesting practice for troponin assays.