title: Impact of cardiac magnetic resonance imaging on cardiac device and surgical therapy: a prospective study.
abstract: Cardiac magnetic resonance (CMR) imaging may allow more appropriate selection of patients for cardiac device implantation and/or cardiac surgery. In this prospective observational study we evaluated the impact of CMR imaging on cardiac device and surgical therapy. All CMR examinations performed in a single centre over a 2 year period were prospectively recorded in a dedicated database under 4 clinical pathways [cardiomyopathy, viability, tumour/mass and arrythmogenic right ventricular cardiomyopathy (ARVC)]. Baseline data entered included planned cardiac device implantation and/or cardiac surgical intervention. Patients were contacted 6 months following CMR to evaluate the impact of CMR on planned therapy. Cost savings due to CMR were calculated as the number of surgical or device procedures averted following CMR scanning multiplied by their respective cost weights. Of 732 CMR examinations performed, the clinical pathway was cardiomyopathy in 488 (67 %), ARVC in 118 (16 %), viability in 92 (12 %) and tumour/mass in 34 (5 %). Six month follow-up was available in 666/732 patients. Following CMR, 56/150 (37 %) of patients with an initial plan for device implantation or cardiac surgery, did not undergo the planned intervention (P < 0.001, one-sample exact binomial test). Of 516 patients without an initial device or surgical plan, 33 (6 %) CMR resulted in device implantation or cardiac surgery (P < 0.001, Chi squared). Overall, the estimated saving due to CMR-guided management changes was AUD$737,270. CMR has a significant impact on patient management and offers potential cost savings with respect to selection of device and surgical therapy for cardiac disease.
authors.affiliation: Alfred Heart Centre and BakerIDI Heart and Diabetes Research Institute, Melbourne, Australia. andrew.taylor@bakeridi.edu.au
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Taylor
authors.forename: Andris
authors.initials: A
authors.lastname: Ellims
authors.forename: Philip J K
authors.initials: PJ
authors.lastname: Lew
authors.forename: Bridie
authors.initials: B
authors.lastname: Murphy
authors.forename: Suzana
authors.initials: S
authors.lastname: Pally
authors.forename: Sandra
authors.initials: S
authors.lastname: Younie
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D002304:Cardiac Pacing, Artificial / Q000191:economics; D006348:Cardiac Surgical Procedures / Q000191:economics; D016009:Chi-Square Distribution; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D017147:Defibrillators, Implantable; D004554:Electric Countershock / Q000191:economics / Q000295:instrumentation; D005260:Female; D017048:Health Care Costs; D006331:Heart Diseases / Q000175:diagnosis* / Q000191:economics / Q000601:surgery / Q000628:therapy*; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000191:economics; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D018579:Patient Selection; D011237:Predictive Value of Tests; D011446:Prospective Studies; D055815:Young Adult