Stress cardiac magnetic resonance imaging with observation unit care reduces cost for patients with emergent chest pain

A randomized trial

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

Research output: Contribution to journalArticle

59 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
JournalAnnals of Emergency Medicine
Volume56
Issue number3
DOIs
StatePublished - Jan 1 2010

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Chest Pain
Acute Coronary Syndrome
Magnetic Resonance Imaging
Observation
Costs and Cost Analysis
Inpatients
Hospital Costs
Confidence Intervals
Hospital Emergency Service
Hospitalization
Biomarkers
Myocardial Infarction

All Science Journal Classification (ASJC) codes

  • Emergency Medicine

Cite this

Miller, Chadwick D. ; Hwang, Wenke ; Hoekstra, James W. ; Case, Doug ; Lefebvre, Cedric ; Blumstein, Howard ; Hiestand, Brian ; Diercks, Deborah B. ; Hamilton, Craig A. ; Harper, Erin N. ; Hundley, W. Gregory. / Stress cardiac magnetic resonance imaging with observation unit care reduces cost for patients with emergent chest pain : A randomized trial. In: Annals of Emergency Medicine. 2010 ; Vol. 56, No. 3.
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abstract = "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.",
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Miller, CD, Hwang, W, Hoekstra, JW, Case, D, Lefebvre, C, Blumstein, H, Hiestand, B, Diercks, DB, Hamilton, CA, Harper, EN & Hundley, WG 2010, 'Stress cardiac magnetic resonance imaging with observation unit care reduces cost for patients with emergent chest pain: A randomized trial', Annals of Emergency Medicine, vol. 56, no. 3. https://doi.org/10.1016/j.annemergmed.2010.04.009

Stress cardiac magnetic resonance imaging with observation unit care reduces cost for patients with emergent chest pain : A randomized trial. / Miller, Chadwick D.; Hwang, Wenke; Hoekstra, James W.; Case, Doug; Lefebvre, Cedric; Blumstein, Howard; Hiestand, Brian; Diercks, Deborah B.; Hamilton, Craig A.; Harper, Erin N.; Hundley, W. Gregory.

In: Annals of Emergency Medicine, Vol. 56, No. 3, 01.01.2010.

Research output: Contribution to journalArticle

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T1 - Stress cardiac magnetic resonance imaging with observation unit care reduces cost for patients with emergent chest pain

T2 - A randomized trial

AU - Miller, Chadwick D.

AU - Hwang, Wenke

AU - Hoekstra, James W.

AU - Case, Doug

AU - Lefebvre, Cedric

AU - Blumstein, Howard

AU - Hiestand, Brian

AU - Diercks, Deborah B.

AU - Hamilton, Craig A.

AU - Harper, Erin N.

AU - Hundley, W. Gregory

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N2 - 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.

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