Study: Cardiac MR in the ER trims hospital admissions, costs
Imaging with stress cardiac MRI in an observation unit can reduce incident cost without missing acute coronary syndrome in patients with emergent chest pain when compared to inpatient care, according to a study published online May 31 in the Annals of Emergency Medicine.
The study sought to determine whether an observation unit strategy involving stress cardiac MRI reduced incident cost. Researchers selected a cohort of patients with emergent intermediate or high risk chest pain who otherwise would be managed via an inpatient care strategy.
"Every year, millions of people in the U.S. visit the emergency department because they are experiencing chest pain. A lot of those people end up being admitted to the hospital unnecessarily,” explained Chadwick D. Miller, MD, from the department of emergency medicine at Wake Forest University School of Medicine in Winston-Salem, N.C.
Researchers randomly assigned 110 patients presenting to the emergency room at North Carolina Baptist Hospital with chest pain at intermediate or high probability for acute coronary syndrome without electrocardiographic or biomarker evidence of a myocardial infarction to stress cardiac MRI in an observation unit or to a standard inpatient care cohort.
Miller and colleagues established that the study’s primary outcome was direct hospital cost calculated as the sum of hospital and provider costs and used estimated average cost differences to compare the two cohorts.
Of the 110 study participants, 53 were randomized to cardiac MRI and 57 to inpatient care. In the inpatient cohort, 39 of 57 patients initially received stress testing, 54 of 57 were admitted, three left against medical advice and six experienced acute coronary syndrome. Of the 53 patients in the observational MRI group, 49 underwent stress cardiac MRI, 11 were admitted, one left against medical advice, 41 were discharged and two experienced acute coronary syndrome, wrote the authors.
At the 30-day follow-up period, the researchers found that no patients from either group experienced acute coronary syndrome after discharge from the hospital, and the cardiac MRI group had a reduced average hospitalization cost estimated at $588. In total, 79 percent of patients were managed without hospital admission.
"To be able to either provide patients with the reassurance that their chest pain isn't related to a more serious cardiac problem and get them back home within a day or to diagnose the cardiac problem more quickly and begin treatment is really satisfying," said Miller.
Noting that the researchers were unable to determine whether the observation unit care, cardiac MRI test or the combination of the two methods were responsible for the study’s results, Miller noted that the next step in the research will be to test the practice at other medical centers and in larger populations before changing standard practice.
The study sought to determine whether an observation unit strategy involving stress cardiac MRI reduced incident cost. Researchers selected a cohort of patients with emergent intermediate or high risk chest pain who otherwise would be managed via an inpatient care strategy.
"Every year, millions of people in the U.S. visit the emergency department because they are experiencing chest pain. A lot of those people end up being admitted to the hospital unnecessarily,” explained Chadwick D. Miller, MD, from the department of emergency medicine at Wake Forest University School of Medicine in Winston-Salem, N.C.
Researchers randomly assigned 110 patients presenting to the emergency room at North Carolina Baptist Hospital with chest pain at intermediate or high probability for acute coronary syndrome without electrocardiographic or biomarker evidence of a myocardial infarction to stress cardiac MRI in an observation unit or to a standard inpatient care cohort.
Miller and colleagues established that the study’s primary outcome was direct hospital cost calculated as the sum of hospital and provider costs and used estimated average cost differences to compare the two cohorts.
Of the 110 study participants, 53 were randomized to cardiac MRI and 57 to inpatient care. In the inpatient cohort, 39 of 57 patients initially received stress testing, 54 of 57 were admitted, three left against medical advice and six experienced acute coronary syndrome. Of the 53 patients in the observational MRI group, 49 underwent stress cardiac MRI, 11 were admitted, one left against medical advice, 41 were discharged and two experienced acute coronary syndrome, wrote the authors.
At the 30-day follow-up period, the researchers found that no patients from either group experienced acute coronary syndrome after discharge from the hospital, and the cardiac MRI group had a reduced average hospitalization cost estimated at $588. In total, 79 percent of patients were managed without hospital admission.
"To be able to either provide patients with the reassurance that their chest pain isn't related to a more serious cardiac problem and get them back home within a day or to diagnose the cardiac problem more quickly and begin treatment is really satisfying," said Miller.
Noting that the researchers were unable to determine whether the observation unit care, cardiac MRI test or the combination of the two methods were responsible for the study’s results, Miller noted that the next step in the research will be to test the practice at other medical centers and in larger populations before changing standard practice.