Schulich Heart Program Sunnybrook Health Sciences Centre University of Toronto Canada.
Institute of Health Policy Management, and Evaluation University of Toronto Canada.
J Am Heart Assoc. 2020 Nov 3;9(21):e017330. doi: 10.1161/JAHA.120.017330. Epub 2020 Oct 22.
Background The relationship between noninvasive cardiac diagnostic testing intensity and downstream clinical outcomes is unclear. Our objective was to examine the relationship between hospital network noninvasive cardiac diagnostic testing intensity and downstream clinical outcomes in patients who were discharged from the emergency department after assessment for chest pain. Methods and Results We employed a retrospective cohort study design of 387 809 patients evaluated for chest pain in the emergency department between April 1, 2010 and March 31, 2016. Hospital networks were divided into tertiles based on usage of noninvasive cardiac diagnostic testing. The primary outcome was a composite of acute myocardial infarction or all-cause mortality. Adjusted Cox proportional hazards models were used to compare the hazard of the composite outcome of myocardical infarction and/or all-cause mortality between the tertiles. After adjustment for clinically relevant covariates, patients evaluated for chest pain in intermediate noninvasive cardiac diagnostic testing usage tertile hospital networks did not have significantly different hazards of the composite outcome when compared with those evaluated in low usage tertile hospital networks >90 days (hazard ratio [HR], 1.00; 95% CI, 0.83-1.21), 6 months (HR, 1.07; 95% CI, 0.92-1.24), and 1 year (HR, 1.03; 95% CI, 0.94-1.14). Patients evaluated in the high usage tertile also did not have significantly different hazards of the composite outcome compared with those evaluated in the low usage tertile at 90 days (HR, 0.98; 95% CI, 0.80-1.19), 6 months (HR, 1.01; 95% CI, 0.87-1.17); and 1 year (HR, 0.95; 95% CI, 0.86-1.05). Conclusions Our population-based study demonstrated that high noninvasive cardiac diagnostic testing use intensity was not associated with reductions in downstream myocardial infarction or all-cause mortality.
非侵入性心脏诊断检测强度与下游临床结局之间的关系尚不清楚。我们的目的是研究在因胸痛而接受评估后从急诊科出院的患者中，医院网络非侵入性心脏诊断检测强度与下游临床结局之间的关系。
我们采用回顾性队列研究设计，纳入了 2010 年 4 月 1 日至 2016 年 3 月 31 日期间因胸痛在急诊科接受评估的 387809 例患者。根据非侵入性心脏诊断检测的使用情况，将医院网络分为三分位。主要结局是急性心肌梗死或全因死亡率的复合结局。采用校正后的 Cox 比例风险模型比较了三分位之间心肌梗死和/或全因死亡率复合结局的风险。在调整了临床相关协变量后，与低使用率三分位医院网络相比，中使用率三分位医院网络评估的胸痛患者在 90 天（风险比[HR]，1.00；95%CI，0.83-1.21）、6 个月（HR，1.07；95%CI，0.92-1.24）和 1 年（HR，1.03；95%CI，0.94-1.14）时，复合结局的风险无显著差异。与低使用率三分位相比，高使用率三分位评估的胸痛患者在 90 天（HR，0.98；95%CI，0.80-1.19）、6 个月（HR，1.01；95%CI，0.87-1.17）和 1 年（HR，0.95；95%CI，0.86-1.05）时，复合结局的风险也无显著差异。
我们的基于人群的研究表明，高非侵入性心脏诊断检测使用强度与降低下游心肌梗死或全因死亡率无关。
