Document Detail


Stress cardiac magnetic resonance imaging with observation unit care reduces cost for patients with emergent chest pain: a randomized trial.
MedLine Citation:
PMID:  20554078     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
STUDY OBJECTIVE: We determine whether imaging with cardiac magnetic resonance imaging (MRI) in an observation unit would reduce medical costs among patients with emergent non-low-risk chest pain who otherwise would be managed with an inpatient care strategy.
METHODS: Emergency department patients (n=110) at intermediate or high probability for acute coronary syndrome without electrocardiographic or biomarker evidence of a myocardial infarction provided consent and were randomized to stress cardiac MRI in an observation unit versus standard inpatient care. The primary outcome was direct hospital cost calculated as the sum of hospital and provider costs. Estimated median cost differences (Hodges-Lehmann) and distribution-free 95% confidence intervals (Moses) were used to compare groups.
RESULTS: There were 110 participants with 53 randomized to cardiac MRI and 57 to inpatient care; 8 of 110 (7%) experienced acute coronary syndrome. In the MRI pathway, 49 of 53 underwent stress cardiac MRI, 11 of 53 were admitted, 1 left against medical advice, 41 were discharged, and 2 had acute coronary syndrome. In the inpatient care pathway, 39 of 57 patients initially received stress testing, 54 of 57 were admitted, 3 left against medical advice, and 6 had acute coronary syndrome. At 30 days, no subjects in either group experienced acute coronary syndrome after discharge. The cardiac MRI group had a reduced median hospitalization cost (Hodges-Lehmann estimate $588; 95% confidence interval $336 to $811); 79% were managed without hospital admission.
CONCLUSION: Compared with inpatient care, an observation unit strategy involving stress cardiac MRI reduced incident cost without any cases of missed acute coronary syndrome in patients with emergent chest pain.
Authors:
Chadwick D Miller; Wenke Hwang; James W Hoekstra; Doug Case; Cedric Lefebvre; Howard Blumstein; Brian Hiestand; Deborah B Diercks; Craig A Hamilton; Erin N Harper; W Gregory Hundley
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2010-05-31
Journal Detail:
Title:  Annals of emergency medicine     Volume:  56     ISSN:  1097-6760     ISO Abbreviation:  Ann Emerg Med     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-08-23     Completed Date:  2010-09-29     Revised Date:  2013-07-24    
Medline Journal Info:
Nlm Unique ID:  8002646     Medline TA:  Ann Emerg Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  209-219.e2     Citation Subset:  AIM; IM    
Copyright Information:
Copyright (c) 2010 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.
Affiliation:
Department of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
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MeSH Terms
Descriptor/Qualifier:
Acute Coronary Syndrome / diagnosis,  economics
Chest Pain / diagnosis,  economics*,  etiology
Costs and Cost Analysis
Electrocardiography
Emergency Service, Hospital / economics*
Exercise Test / economics
Female
Hospitalization / economics
Humans
Magnetic Resonance Imaging* / economics
Male
Middle Aged
Myocardial Infarction / diagnosis,  economics
Outcome and Process Assessment (Health Care) / economics
Grant Support
ID/Acronym/Agency:
R01 HL076438/HL/NHLBI NIH HHS; R01 HL076438-05/HL/NHLBI NIH HHS
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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