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.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of CardiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Myocardial contrast echocardiography versus TIMI score in patients presenting to the emergency department with chest pain and a non-diagnostic electrocardiogram.J Am Coll Cardiol. 2005; 46: 920-927
- Regional left ventricular perfusion and function in patients presenting to the emergency department with chest pain and no ST segment elevation.Eur Heart J. 2005; 26: 1606-1611
- Effect of time delay on the diagnostic and prognostic utility of myocardial contrast echocardiography in patients presenting with suspected cardiac chest pain to the emergency department.J Am Soc Echocardiogr. 2006; 19: 1488-1493
- Measurement of myocardial blood flow velocity reserve with myocardial contrast echocardiography in patients with suspected coronary artery disease: comparison with quantitative gated 99mTc sestamibi SPECT.J Am Soc Echocardiogr. 2003; 16: 1171-1177
- TreeAge Pro 2006 User's manual.in: TreeAge Software, Williamstown, MA2006: 16-25
- Value and limitations of current methods of evaluating patients presenting to the emergency room with cardiac-related symptoms for determining long-term prognosis.Am J Cardiol. 1992; 69:: 746-750
- Cardiac-specific troponin I levels to predict the risk of mortality in patients with acute coronary syndromes.N Engl J Med. 1996; 335: 1342-1349
- Applicability of cardiac troponin T and I for early risk stratification in unstable coronary artery disease.Circulation. 1997; 96: 2578-2585
- Acute chest pain in the emergency room.Arch Intern Med. 1985; 145: 65-69
- Missed diagnoses of acute myocardial infarction in the emergency department: results from a multicenter study.Ann Emerg Med. 1993; 22: 579-582
- The clinical presentation of patients with acute cardiac ischemia in the emergency department: a multicenter controlled clinical trial.J Thromb Thrombolysis. 1998; 6: 63-74
- Clinical characteristics and natural history of patients with acute myocardial infarction sent home from the emergency room.Am J Cardiol. 1987; 60: 219-224
- Cost-effectiveness analysis and incremental cost-effectiveness ratios: uses and pitfalls.Eur J Gatroenterol Hepatol. 2004; 16: 519-526
- Clinical decision and limited resources.in: Clinical decision analysis. Saunders, Philadelphia, PA1998: 228-265
- Immediate exercise testing to evaluate low risk patients presenting to the emergency department with chest pain.J Am Coll Cardiol. 2002; 40: 251-256
- Safety and utility of exercise testing in emergency room chest pain centers.Circulation. 2000; 102: 1463-1467
- Comparison of early dobutamine stress echocardiography and exercise electrocardiographic testing for management of patients presenting to the emergency department with chest pain.Am J Cardiol. 2007; 100: 1068-1073
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.
