Baugh Christopher W, Pena Margarita E, Takla Robert B, Hadri Ahmad O, Mace Sharon E
Brigham and Women's Hospital, Department of Emergency Medicine, Harvard Medical School, Boston, MA, United States of America.
Ascension St. John Hospital, Department of Emergency Medicine, Detroit, MI, United States of America.
Am Heart J Plus. 2024 Jul 31;45:100434. doi: 10.1016/j.ahjo.2024.100434. eCollection 2024 Sep.
Patients frequently present to the emergency department (ED) with chest pain requiring further risk stratification. Traditional cardiac diagnostics such as stress testing may expose patients to ionizing radiation, may not be readily available, may take significant time for testing and interpretation, and adds cost to the workup. Magnetocardiography (MCG) is an alternative approach to assess candidates more quickly and efficiently than routine downstream testing.
We created and ran 1000 trials of a Monte Carlo simulation. Using this simulation, we modeled the national annual impact by averting further cardiac diagnostics.
All EDs in the United States.
All ED adult patients with chest pain.
Simulated use of MCG to reduce avoidable downstream cardiac diagnostics.
Our primary outcome was to estimate the impact of an MCG-first strategy on the annual national cost savings among eligible patients in the ED. Our secondary outcomes were the estimated reduction in short-stay hospitalizations, cancer cases, and cancer deaths due to radiation exposure.
An MCG-first strategy was estimated to save a mean (±SD) of $574 million (±$175 million) by avoiding 555,000 (±93,000) downstream cardiac diagnostic tests. This resulted in a national annual cumulative decrease of 500,000 (±84,000) hospitalizations, 7,600,000 (±1,500,000) bed hours, 409 (±110) new cancer diagnoses, and 210 (±56) new cancer deaths due to radiation exposure from avoidable cardiac diagnostics.
If adopted widely and used consistently, an MCG-first strategy among eligible patients could yield substantial benefits by averting avoidable cardiac diagnostic testing.
患者常因胸痛前往急诊科（ED），需要进一步进行风险分层。传统的心脏诊断方法，如负荷试验，可能会使患者暴露于电离辐射，可能无法随时进行，检查和解读可能需要很长时间，并且会增加检查成本。心磁图（MCG）是一种替代方法，比常规的后续检查能更快、更有效地评估患者。
我们创建并运行了1000次蒙特卡洛模拟试验。利用该模拟，我们通过避免进一步的心脏诊断来模拟全国年度影响。
美国所有的急诊科。
所有因胸痛就诊的急诊科成年患者。
模拟使用心磁图以减少不必要的后续心脏诊断。
我们的主要结果是估计在心磁图优先策略下，急诊科符合条件的患者每年在全国节省的成本。次要结果是估计因辐射暴露导致的短期住院、癌症病例和癌症死亡的减少。
据估计，心磁图优先策略通过避免555,000（±93,000）次后续心脏诊断检查，平均（±标准差）节省5.74亿美元（±1.75亿美元）。这导致全国每年累计减少500,000（±84,000）次住院、7,600,000（±1,500,000）个住院日、409（±110）例新癌症诊断以及210（±56）例因可避免的心脏诊断辐射暴露导致的新癌症死亡。
如果广泛且持续采用，符合条件的患者采用心磁图优先策略可通过避免不必要的心脏诊断检查带来显著益处。
