Cost-Efficiency of Myocardial Contrast Echocardiography in Patients Presenting to the Emergency Department With Chest Pain of Suspected Cardiac Origin and a Nondiagnostic Electrocardiogram

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)649-652
Number of pages4
JournalAmerican Journal of Cardiology
Volume102
Issue number6
DOIs
StatePublished - Sep 15 2008

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Chest Pain
Echocardiography
Hospital Emergency Service
Electrocardiography
Costs and Cost Analysis
Patient Discharge
Medicare
Decision Making
Myocardial Infarction
Economics
Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

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title = "Cost-Efficiency of Myocardial Contrast Echocardiography in Patients Presenting to the Emergency Department With Chest Pain of Suspected Cardiac Origin and a Nondiagnostic Electrocardiogram",
abstract = "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.",
author = "Wyrick, {Jared J.} and Saul Kalvaitis and McConnell, {Kenneth (John)} and Diana Rinkevich and Sanjiv Kaul and Kevin Wei",
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T1 - Cost-Efficiency of Myocardial Contrast Echocardiography in Patients Presenting to the Emergency Department With Chest Pain of Suspected Cardiac Origin and a Nondiagnostic Electrocardiogram

AU - Wyrick, Jared J.

AU - Kalvaitis, Saul

AU - McConnell, Kenneth (John)

AU - Rinkevich, Diana

AU - Kaul, Sanjiv

AU - Wei, Kevin

PY - 2008/9/15

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N2 - 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.

AB - 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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