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Use of Cardiac Noninvasive Testing After Emergency Department Discharge: Association of Hospital Network Testing Intensity and Outcomes in Ontario, Canada.
- Source :
-
Journal of the American Heart Association [J Am Heart Assoc] 2020 Nov 03; Vol. 9 (21), pp. e017330. Date of Electronic Publication: 2020 Oct 22. - Publication Year :
- 2020
-
Abstract
- 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.
- Subjects :
- Aged
Chest Pain etiology
Female
Humans
Male
Middle Aged
Ontario
Outcome and Process Assessment, Health Care
Procedures and Techniques Utilization
Proportional Hazards Models
Retrospective Studies
Chest Pain diagnosis
Chest Pain mortality
Emergency Service, Hospital
Heart Function Tests statistics & numerical data
Myocardial Infarction epidemiology
Patient Discharge
Subjects
Details
- Language :
- English
- ISSN :
- 2047-9980
- Volume :
- 9
- Issue :
- 21
- Database :
- MEDLINE
- Journal :
- Journal of the American Heart Association
- Publication Type :
- Academic Journal
- Accession number :
- 33086926
- Full Text :
- https://doi.org/10.1161/JAHA.120.017330