« Previous Next » Annals of Emergency Medicine
Volume 56, Issue 3 , Pages 209-219.e2 , September 2010

Stress Cardiac Magnetic Resonance Imaging With Observation Unit Care Reduces Cost for Patients With Emergent Chest Pain: A Randomized Trial

Presented at the American Heart Association Scientific Sessions, November 2009, Orlando, FL; and the Society for Cardiac Magnetic Resonance annual meeting, January 2009, Orlando, FL.

Chadwick D. Miller, MD, MS
- Department of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
- Address for correspondence: Chadwick D. Miller, MD, MS, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157; 336-716-1740, fax 336-716-1705
Wenke Hwang, PhD
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC
James W. Hoekstra, MD
- Department of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
Doug Case, PhD
- Department of Biostatistical Sciences, Wake Forest University School of Medicine, Winston-Salem, NC
Cedric Lefebvre, MD
- Department of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
Howard Blumstein, MD
- Department of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
Brian Hiestand, MD, MPH
- Department of Emergency Medicine, Ohio State University Medical Center, Columbus, OH
Deborah B. Diercks, MD, MSc
- Department of Emergency Medicine, University of California, Davis Medical Center, Sacramento, CA
Craig A. Hamilton, PhD
- Department of Biomedical Engineering, Wake Forest University School of Medicine, Winston-Salem, NC
Erin N. Harper, BS
- Department of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
W. Gregory Hundley, MD
- Departments of Internal Medicine/Cardiology and Radiology, Wake Forest University School of Medicine, Winston-Salem, NC

Received 12 January 2010 ,Revised 5 April 2010 ,Accepted 12 April 2010.

Screening, enrollment, randomization, and follow-up of patients in the trial.

Screening, enrollment, randomization, and follow-up of patients in the trial.
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Distributions of cost for study participants in the inpatient care group (INPAT) (n=57) and observation unit–cardiac MRI (OUCMR) group (n=53). All participants have some reported cost for each categor

Distributions of cost for study participants in the inpatient care group (INPAT) (n=57) and observation unit–cardiac MRI (OUCMR) group (n=53). All participants have some reported cost for each category unless otherwise noted. A, ED facility cost. B, Laboratory testing cost. C, Catheterization and revascularization cost, no cost n=48 INPAT, n=45 OUCMR. D, Noninvasive imaging cost. E, Pharmacy-associated cost, no cost n=1 INPAT, n=0 OUCMR. F, Inpatient facility cost, no cost n=3 INPAT, n=30 OUCMR. G, Total nonprovider cost representing the sum of cost in A to F. H, Total provider cost. I, Total cost of care, representing the sum of cost in G and H.
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Distributions of cost for study participants in the inpatient care group (INPAT) (n=57) and observation unit–cardiac MRI (OUCMR) group (n=53). All participants have some reported cost for each categor

Distributions of cost for study participants in the inpatient care group (INPAT) (n=57) and observation unit–cardiac MRI (OUCMR) group (n=53). All participants have some reported cost for each category unless otherwise noted. A, ED facility cost. B, Laboratory testing cost. C, Catheterization and revascularization cost, no cost n=48 INPAT, n=45 OUCMR. D, Noninvasive imaging cost. E, Pharmacy-associated cost, no cost n=1 INPAT, n=0 OUCMR. F, Inpatient facility cost, no cost n=3 INPAT, n=30 OUCMR. G, Total nonprovider cost representing the sum of cost in A to F. H, Total provider cost. I, Total cost of care, representing the sum of cost in G and H.
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Total cost by TIMI risk score, inpatient care, n=57, and observation unit–cardiac MRI (OUCMR), n=53.

Total cost by TIMI risk score, inpatient care, n=57, and observation unit–cardiac MRI (OUCMR), n=53.
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Distributions of revenue from participants by study group, inpatient care, n=57, and observation unit–cardiac MRI (OUCMR), n=53. A, Provider revenue. B, Nonprovider revenue. C, Total revenue, represen

Distributions of revenue from participants by study group, inpatient care, n=57, and observation unit–cardiac MRI (OUCMR), n=53. A, Provider revenue. B, Nonprovider revenue. C, Total revenue, representing the sum of A and B.
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Please see page 210 for the Editor's Capsule Summary of this article.

Dr. Hwang is now affiliated with Penn State Hershey College of Medicine, Hershey, PA.

Supervising editor: Judd E. Hollander, MD

Author contributions: CDM, WH, JWH, DC, CAH, and WGH were responsible for conceiving and designing the study. CDM and WGH obtained research funding. CDM supervised the conduct of the trial. HB was the study safety monitor and analyzed and interpreted events. Data acquisition was performed by CDM, JWH, CL, and ENH. Data analysis was performed by CDM and DC. Data interpretation was performed by all authors. BH and DBD analyzed, interpreted, and adjudicated clinical endpoints. CDM drafted the article. All authors revised it critically for important intellectual content and granted final approval of the article. CDM takes responsibility for the paper as a whole.

Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article that might create any potential conflict of interest. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement. Funded by the Translational Science Institute of Wake Forest University School of Medicine. Dr. Miller has received research support from Biosite, Schering-Plough, Siemens, and Heartscape Technologies Inc; has been a consultant for Molecular Insight and the Medicines Co; and has been a speaker for Sanofi-Aventis (indirect sponsor of a CME event). Dr. Lefebvre has received research support from Heartscape Technologies Inc.

Reprints not available from the authors.

Publication date: Available online May 31, 2010.

PII: S0196-0644(10)00375-6

doi: 10.1016/j.annemergmed.2010.04.009

« Previous Next » Annals of Emergency Medicine
Volume 56, Issue 3 , Pages 209-219.e2 , September 2010