RANDOMIZED COST COMPARISON OF CARDIAC MRI USE IN EMERGENCY DEPARTMENT PATIENTS WITH CHEST PAIN

Objective To compare the medical cost among patients with intermediate-risk chest pain managed with two diagnostic strategies: an observation unit (OU) cardiac MRI (CMR) strategy and inpatient care. Methods A single center clinical trial randomized 110 patients with intermediate-risk chest pain (TIMI ≥2 or clinical impression) to OU CMR (OU care, serial cardiac markers and stress CMR) or inpatient care (admission, care determined by the admitting provider). Outcomes included direct cost of the index hospital visit and correct cardiac dispositions. Results 53 subjects were randomized to OU CMR and 57 to inpatient care; In the OU CMR group, 49/53 underwent stress CMR, 11/53 were admitted, 1 left against medical advice (AMA), and 41 were discharged. Of inpatient care participants, 54/57 were admitted and 3 left AMA. ACS occurred in 2 patients in the OU CMR group and 6 in the inpatient care group. At 30 days no subjects experienced ACS after discharge. OU CMR was associated with reduced median index hospitalization cost ($2062 vs $2680, p<0.001). OU CMR improved cardiac disposition decisions (83% vs 11%, p<0.001). Conclusion In patients with intermediate-risk chest pain, an OU CMR strategy reduces cost and improves cardiac disposition decisions with similar outcomes at 30 days.

Grantor dc:publisher

Wake Forest University

Year dc:date.issued

2009

Author dc:creator

• Miller, Chadwick

• Costs and Cost Analysis

Language dc:language.iso

en_US

Handle dc:identifier.uri

http://hdl.handle.net/10339/14773

OAI identifier oai:identifier

oai:wakespace.lib.wfu.edu:10339/14773