In a small,
single-center clinical trial, Chadwick Miller, M.D., M.S., and
colleagues found that evaluating older, more complex patients in the
observation unit with stress cardiac MRI, as opposed to usual inpatient
care, reduced hospital readmissions, coronary revascularization
procedures and the need for additional cardiac testing.
The
observation unit is an area of the Emergency Department designed for
short stays - longer than a typical ED visit, said Miller, but shorter
than a hospital admission. Cardiac MRI is a type of heart testing that
uses magnetic forces to capture pictures of the heart.
"We were
looking at the optimum way to evaluate people with chest pain and
focusing on those patients who are generally older, have many risk
factors for coronary disease or may have had prior health problems,
basically the intermediate to higher risk population," Miller said. "At
most hospitals in the United States, after evaluation in the emergency
department, these patients are admitted to the hospital to complete
their care."
The study appears online this month ahead of print in the journal JACC: Cardiovascular Imaging.
Miller,
who serves as director of clinical research and executive vice-chair of
Emergency Medicine at Wake Forest Baptist, said the study built on
previous research findings that more complex patients managed in an
observation unit with stress CMR testing experienced a reduction in care
costs of about $2,100 per patient per year. For the new study, the
researchers wanted to specifically look at three care events: coronary
revascularization, hospital readmissions and additional heart testing.
The
researchers recruited 105 patients from Wake Forest Baptist's Emergency
Department, randomizing them to receive care either in the Observation
Unit with CMR or in the hospital. The patients were followed for 90
days, after which the researchers found significant reductions in
coronary revascularization procedures, fewer hospital readmissions and
fewer recurrent cardiac testing episodes or the need for additional
testing.
"What's exciting about this is not only can we reduce
events that are important to patients, but we can reduce costs as well,"
Miller said. "What we think is happening is that the cardiac MRI is
more accurately selecting patients who will benefit the most from having
invasive procedures done. It's a win-win."
The single-center
design of the study is a limitation, Miller said, and these findings
need to be replicated across multiple centers to validate the findings.
The study was funded by National Institutes of Health's National Heart, Lung, and Blood Institute, grant 1 R21HL097131-01A1; 1 R01HL076438, NIH T-32 HL087730.
Co-authors include: L. Douglas Case, Ph.D., William
C. Little, M.D., Simon A. Mahler, M.D., Gregory L. Burke, M.D., MSc.,
Erin N. Harper, B.S., Cedric Lefebvre, M.D., Brian Hiestand, M.D.,
M.P.H., James W. Hoekstra, M.D., Craig A. Hamilton, Ph.D., W. Gregory
Hundley, M.D., all of Wake Forest Baptist.