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Cardiac MRI in ER Cuts Costs, Admissions

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Someone shows up at the emergency room with chest pain. An initial consultation categorizes the patient as “non-low risk.” Next step: hospital admission for tests and further evaluation, right?

Not so fast, say researchers at Wake Forest University Baptist Medical Center. Instead, their new study suggests placing such patients in an observation unit, monitoring them carefully, and stress testing them with cardiac MRI—which, though highly accurate for people with chest pain, is not commonly used for such patients in emergency departments.

The study found that these procedures saved money (by reducing the number of hospital admissions and tests), allowed patients who turned out not to have serious problems to go home quickly, and still identified all patients who were indeed suffering serious cardiac events.

“Every year, millions of people in the United States visit the emergency department because they are experiencing chest pain,” said Chadwick D. Miller, MD, an assistant professor of emergency medicine at Wake Forest Baptist Medical Center and lead author of the study. He was quoted in a medical center news release.

“A lot of these people end up being admitted to the hospital unnecessarily. To be able to either provide patients with the reassurance that their chest pain isn’t related to a more serious cardiac problem and get them back home within a day, or to diagnose the cardiac problem more quickly and begin treatment, is really satisfying.”

Dr. Miller said nearly half of the 6 million people each year who visit U.S. emergency rooms with chest pain are categorized as “non-low risk” and as a result admitted to a hospital for testing and evaluation. That, he said, leads to over-triaging of patients because only a small fraction end up suffering a serious cardiac event.

“The over-triaging and working up of people who don’t ultimately have cardiac events leads to a lot of spending—about $10 billion a year,” he said. “That’s a big deal.”

Indeed. No wonder Dr. Miller sounds pumped up about the study results:

This is probably one of the studies I’m most excited about being involved with. We were able to reduce cost, not miss any cardiac events, and reduce hospital admissions at the same time.

The results of the study have been published online in the Annals of Emergency Medicine.

Next step: testing the idea at other medical centers and in a larger population than the 110 patients involved in this study. Stay tuned.

Related seminar: Cardiac Imaging (just released; latest techniques)


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