ED cardiac imaging leads to more testing, but benefits are questionable

A study published online in JAMA: Internal Medicine has found that while there is a wide variation in the use of non-invasive imaging for patients presenting at emergency departments with chest pain, hospitals with higher rates of imaging didn't see lower readmission rates within the subsequent month.

The study analyzed more than 220 U.S. hospitals and involved roughly 550,000 patients; researchers found that the use of noninvasive imaging tests ranged from 0.2 percent to 55.7 percent. Myocardial perfusion imaging (80.4 percent) and stress echocardiograms (16.6 percent) were among the most commonly used imaging tests.

"We found a remarkable variation in the use of imaging, which is an expensive intervention, and its use was strongly linked to what happened to the patient subsequently," senior investigator Harlan Krumholz of Yale University School of Medicine told Heartwire. "The testing cascade has been discussed in other articles, but this is more proof that the more expensive tests you do the more likely you are to pursue additional tests."

Despite such variations, there was no difference in the percentage of patients being readmitted to the hospital with the month after presenting in the emergency room.

"There's no evidence, at least that we could find, that there were improvements in outcomes with the more intensive strategies," Krumholz told Reuters Health. "It seems that hospitals have particular cultures and approaches and the way in which a patient is going to be treated has more to do with which hospital door they walk into rather than their own particular characteristics."

In a commentary accompanying the study, University of California San Francisco cardiologist Rita Redberg lobbied for doctors to spend more time talking with patients about their symptoms and functional status, as well as the risks and benefits of immediate vs. deferred testing. "Certainly, no one wants to miss a myocardial infarction, but we also do not want to keep people for hours and days to perform additional imaging tests that are not associated with better outcomes but may lead to increased radiation exposure," Redberg said.

To learn more:
- see the study in JAMA: Internal Medicine
- check out the commentary by Rita Redberg
- read the Heartwire article
- see the Reuters Health article

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