Assessment of patients presenting to the emergency department (ED) with suspected
cardiac chest pain and a nondiagnostic electrocardiogram (ECG) is lengthy and costly.
It was hypothesized that myocardial contrast echocardiography (MCE) can be cost-efficient
in such patients by detecting those with chest pain that is noncardiac in nature.
Accordingly, cost-efficiency was evaluated in 957 patients presenting to the ED with
suspected cardiac chest pain, but no ST-segment elevation on the ECG, who underwent
MCE. Economic outcome calculations were based on costs estimated from national average
Medicare charges adjusted by a cost–charge ratio. Based on routine clinical criteria,
641 patients (67%) were admitted to the hospital, whereas 316 (33%) were discharged
directly from the ED. The average cost per patient using routine evaluation was $5,000.
Patients with normal MCE results (n = 523) had a very low primary event rate (death,
acute myocardial infarction) of 0.6% within 24 hours after presentation, making it
relatively safe to discharge patients directly from the ED with a normal MCE result.
Hence, if MCE had been used for decision making, 523 patients (55%) would have been
discharged directly from the ED and 434 (45%) would have been admitted to the hospital.
Preventing unnecessary admissions and tests would have saved an average of $900 per
patient, in addition to reducing their ED stay. In conclusion, by excluding cardiac
causes in patients presenting to the ED with chest pain and a nondiagnostic ECG, MCE
can prevent unnecessary admissions and downstream resource utilization, making it
a cost-efficient tool in the evaluation of these patients.
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Article Info
Publication History
Published online: July 10, 2008
Accepted:
May 1,
2008
Received in revised form:
May 1,
2008
Received:
February 14,
2008
Footnotes
This work was supported by a grant from GE Healthcare, Milwaukee, Wisconsin. Dr. Kaul was supported by Grants RO1-HL48890 and RO1-HL66034 from the National Institutes of Health, Bethesda, Maryland, and the American Society of Echocardiography, Raleigh, North Carolina.
Identification
Copyright
© 2008 Elsevier Inc. Published by Elsevier Inc. All rights reserved.