Comparison of early dobutamine stress echocardiography and exercise electrocardiographic testing for management of patients presenting to the emergency department with chest pain.
This study compared the cost-effectiveness of dobutamine-atropine stress echocardiography (DASE) and electrocardiographic exercise testing (EET) implemented in emergency department accelerated diagnostic protocols for the early stratification of low-risk patients presenting with acute chest pain (ACP). One hundred ninety-nine patients with ACP, nondiagnostic electrocardiographic results, and negative biomarker results were randomized to DASE (n = 110) or EET (n = 89) <6 hours after emergency department presentation. Patients with negative risk assessment results were immediately discharged and followed for 2 months. Ninety patients (82%) in the DASE arm and 78 (88%) in the EET arm were discharged after the diagnosis of nonischemic ACP. The mean lengths of stay in the hospital were 23 +/- 12 and 31 +/- 23 hours in the DASE and EET arms, respectively (p = 0.01). No 2-month follow-up events occurred in DASE patients, and the event rate was significantly higher in EET patients (0% vs 11%, p = 0.004). The DASE strategy showed lower costs compared with the EET strategy at 1-month ($1,026 +/- $250 vs $1,329 +/- $1,288, p = 0.03) and 2-month ($1,029 +/- 253 vs $1,684 +/- $2,149, p = 0.005) follow-up. In conclusion, early DASE in emergency department triage of low-risk patients with ACP is safe and reduces costs of care compared to EET.
Nucifora
Gaetano
G
IRCAB Foundation, Udine, Italy. gnucifora@cardionet.it
Badano
Luigi P
LP
Sarraf-Zadegan
Nizal
N
Karavidas
Apostolos
A
Trocino
Giuseppe
G
Scaffidi
Giorgio
G
Pettinati
Gianni
G
Astarita
Costantino
C
Vysniauskas
Vitas
V
Gregori
Dario
D
Ilerigelen
Baris
B
Marinigh
Ricarda
R
Fioretti
Paolo M
PM
D002637:Chest Pain / Q000175:diagnosis*; D025401:Echocardiography, Stress / Q000191:economics*; D004632:Emergency Medical Services / Q000191:economics*; D005080:Exercise Test / Q000191:economics*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors