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Cardiac MRI Use Lessens Unpleasant Events for Patients With Severe Chest Pain

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chest-painWake Forest Baptist Medical Center doctors have discovered that using stress cardiac magnetic resonance (CMR) imaging in an Emergency Department observation unit to care and treat patients with severe chest pain is beneficial for both the patient and the institution. The study appears online in the journal, JACC: Cardiovascular Imaging.

On a small-scale clinical trial, M.D., M.S., Chadwick Miller, who also serves as director of clinical research and executive vice-chair of Emergency Medicine at Wake Forest Baptist, and his team discovered that examining older, more intricate patients in the observation sector with stress cardiac MRI, instead of the usual inpatient care, significantly trimmed down hospital readmissions, coronary revascularization procedures, and the need for additional cardiac testing.

The observation area is an annex of the Emergency Department, purposefully constructed for short stays, longer than a usual ED trip, yet shorter than a hospital admission says Miller. Cardiac MRI is a kind of heart testing that utilizes magnetic forces to capture images of the heart.

"We were looking at the optimum way to evaluate people with chest pain and focusing on those patients who are generally older, have many risk factors for coronary disease or may have had prior health problems, basically the intermediate to higher risk population,” said Miller.

"At most hospitals in the United States, after evaluation in the emergency department, these patients are admitted to the hospital to complete their care,” he added.

Funded by the National Institutes of Health's National Heart, Lung, and Blood Institute, Miller cites that the study was originally predicated on previous works in which more complex patients treated in an observation sector with stress CMR testing resulted a decrease in care costs of around $2,100 for every patient per year. For this new endeavor, researchers wanted to purposely examine and evaluate three care events: coronary revascularization, hospital readmissions and additional heart testing.

Researchers enrolled 105 patients into their study, putting them in random orders to be given treatment either in the observation area with CMR or in the hospital. After a 90 day follow up, researchers discovered major deductions in coronary revascularization procedures, fewer hospital readmissions and fewer recurrent cardiac testing episodes or the need for additional testing.

"What's exciting about this is not only can we reduce events that are important to patients, but we can reduce costs as well," Miller said. "What we think is happening is that the cardiac MRI is more accurately selecting patients who will benefit the most from having invasive procedures done. It's a win-win."

However, the initial small-scale the study was based on doesn’t serve its overall purpose in Miller’s view. Therefore he suggests these discoveries need to be shared and reproduced across a multitude of centers in order to rightfully confirm the findings.

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