Author + information
- Received December 20, 2010
- Revision received March 4, 2011
- Accepted April 18, 2011
- Published online August 1, 2011.
- Chadwick D. Miller, MD, MS⁎,⁎ (, )
- Wenke Hwang, PhD†,
- Doug Case, PhD‡,
- James W. Hoekstra, MD⁎,
- Cedric Lefebvre, MD⁎,
- Howard Blumstein, MD⁎,
- Craig A. Hamilton, PhD§,
- Erin N. Harper, BS⁎ and
- W. Gregory Hundley, MD‖,¶
- ↵⁎Reprint request and correspondence:
Dr. Chadwick D. Miller, Department of Emergency Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina 27357
An abstract of this work was presented at ACC.11/i2 Summit in New Orleans in April 2011.
Objectives This study sought to compare the direct cost of medical care and clinical events during the first year after patients with intermediate risk acute chest pain were randomized to stress cardiac magnetic resonance (CMR) observation unit (OU) testing versus inpatient care.
Background In a recent study, randomization to OU-CMR reduced median index hospitalization cost compared with the cost of inpatient care in patients presenting to the emergency department with intermediate risk acute chest pain.
Methods Emergency department patients with intermediate risk chest pain were randomized to OU-CMR (OU care, cardiac markers, stress CMR) or inpatient care (admission, care per admitting provider). This analysis reports the direct cost of cardiac-related care and clinical outcomes (myocardial infarction, revascularization, cardiovascular death) during the first year of follow-up subsequent to discharge. Consistent with health economics literature, provider cost was calculated from work-related relative value units using the Medicare conversion factor; facility charges were converted to cost using departmental-specific cost-to-charge ratios. Linear models were used to compare cost accumulation among study groups.
Results We included 109 randomized subjects in this analysis (52 OU-CMR, 57 inpatient care). The median age was 56 years; baseline characteristics were similar in both groups. At 1 year, 6% of OU-CMR and 9% of inpatient care participants experienced a major cardiac event (p = 0.72) with 1 patient in each group experiencing a cardiac event after discharge. First-year cardiac-related costs were significantly lower for participants randomized to OU-CMR than for participants receiving inpatient care (geometric mean = $3,101 vs. $4,742 including the index visit [p = 0.004] and $29 vs. $152 following discharge [p = 0.012]). During the year following randomization, 6% of OU-CMR and 9% of inpatient care participants experienced a major cardiac event (p = 0.72).
Conclusions An OU-CMR strategy reduces cardiac-related costs of medical care during the index visit and over the first year subsequent to discharge, without an observed increase in major cardiac events. (Cost Comparison of Cardiac Magnetic Resonance Imaging [MRI] Use in Emergency Department [ED] Patients With Chest Pain; NCT00678639)
Dr. Hwang is now affiliated with the Division of Health Services Research, Department of Public Health Sciences, Penn State Hershey College of Medicine, Hershey, Pennsylvania. This study was supported by grants from the Translational Science Institute of Wake Forest University School of Medicine; the National Institutes of Health (1 R21 HL097131-01A1 [to Dr. Miller] and 1 R01 HL076438 [to Dr. Hundley]); and the American Heart Association (0980008N [to Dr. Miller]). Dr. Miller has received research grants from EKR Therapeutics, Johnson & Johnson/Scios Inc., Chiron Corporation, and Novartis Pharmaceuticals; research support from Siemens; and has been an expert witness for the Law Offices of Wade E. Byrd, P.A., and Lewis and Oliver. Dr. Hoekstra has received consulting fees from Sanofi-Aventis and Verathon; and has served on the advisory boards of Merck & Co. Inc., Ortho-McNeil Pharmaceutical, Daiichi Sankyo, and AstraZeneca. Dr. Hamilton has stock in/ownership of Prova, Inc. Dr. Hundley has received research support from Bracco Diagnostics; and has stock in/ownership of Prova, Inc. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Eike Nagel, MD, PhD, served as Guest Editor for this article.
- Received December 20, 2010.
- Revision received March 4, 2011.
- Accepted April 18, 2011.
- American College of Cardiology Foundation