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Doctor Knows Best On Cardiac Stress Tests

December 6, 2011
Written by: , Filed in: Cardiac Imaging, Emergency Radiology
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When a low-risk patient shows up at the emergency department with chest pain, it’s best to let the doctor decide what kind of stress test to administer.

That may seem obvious, but a new study that came to that conclusion had a reason for exploring the question. The same researchers had found in an earlier study that “doctor’s choice” was not the best strategy for moderate- to high-risk patients, at least from a cost-benefit point of view.

Instead, the earlier study concluded that mandating a cardiac magnetic resonance (CMR) stress test in an observation unit rather than inpatient care was more cost effective.

Chadwick D. Miller, MD, of the department of emergency medicine at Wake Forest School of Medicine in Winston-Salem, North Carolina, led the researchers for both studies. The new study, published online last week in Circulation: Cardiovascular Imaging, looked at 120 patients at a single ED who presented with acute chest pain or other symptoms of acute coronary syndromes.

All received observation-unit care. Half got stress CMR imaging regardless. For the other half, the researchers left the selection of test up to the physician. In the doctor’s-choice group, 62 percent received a stress echo test, 32 percent CMR, 3 percent cardiac catheterization, 2 percent nuclear tests, and 2 percent coronary CT.

Length of stay and outcomes turned out to be similar for both groups. In each group, nontherapeutic catheterization was very low and the appropriateness of admission decisions was high.

But giving doctors options significantly reduced costs. The median cost was $2,050 for the CMR group, $1,686 for the “choice” group. Mean costs were $2,586 and $2,005, respectively.

The study drew the following conclusion:

In these lower risk patients, it appears the physician’s ability to tailor testing to the individual patient, while considering institutional imaging strengths, may be a key to enhanced healthcare efficiency.

So it’s better to let highly trained, highly skilled physicians implement that training and those skills. Imagine that.

Related seminar: Emergency Radiology (brand new)


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