{"id":3033,"date":"2020-10-22T00:00:00","date_gmt":"2020-10-22T04:00:00","guid":{"rendered":"https:\/\/icesontario.wpengine.com\/journal-articles\/use-of-cardiac-noninvasive-testing-after-emergency-department-discharge-association-of-hospital-network-testing-intensity-and-outcomes-in-ontario-canada\/"},"modified":"2023-06-14T20:10:03","modified_gmt":"2023-06-15T00:10:03","slug":"use-of-cardiac-noninvasive-testing-after-emergency-department-discharge-association-of-hospital-network-testing-intensity-and-outcomes-in-ontario-canada","status":"publish","type":"journal_article","link":"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/use-of-cardiac-noninvasive-testing-after-emergency-department-discharge-association-of-hospital-network-testing-intensity-and-outcomes-in-ontario-canada\/","title":{"rendered":"Use of cardiac noninvasive testing after emergency department discharge: association of hospital network testing intensity and outcomes in Ontario, Canada"},"content":{"rendered":"<p><strong>Background <\/strong>&#x2014; 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.<\/p>\n<p><span class=\"bold\">Methods and Results <\/span>&#x2014; 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&#x2010;cause mortality. Adjusted Cox proportional hazards models were used to compare the hazard of the composite outcome of myocardical infarction and\/or all&#x2010;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 &gt;90 days (hazard ratio [HR], 1.00; 95% CI, 0.83&#x2013;1.21), 6 months (HR, 1.07; 95% CI, 0.92&#x2013;1.24), and 1 year (HR, 1.03; 95% CI, 0.94&#x2013;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&#x2013;1.19), 6 months (HR, 1.01; 95% CI, 0.87&#x2013;1.17); and 1 year (HR, 0.95; 95% CI, 0.86&#x2013;1.05).<\/p>\n<p><strong>Conclusions <\/strong>&#x2014; Our population&#x2010;based study demonstrated that high noninvasive cardiac diagnostic testing use intensity was not associated with reductions in downstream myocardial infarction or all&#x2010;cause mortality.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Background &#x2014; 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 &#x2014; We employed [&hellip;]<\/p>\n","protected":false},"template":"","migration-helper-automated":[],"migration-manual":[],"topic":[],"migration-helper-qa-sample-set":[],"class_list":["post-3033","journal_article","type-journal_article","status-publish","hentry"],"acf":{"citation":"Roifman I, Han L, Koh M, Wijeysundera HC, Austin PC, Douglas PS, Ko DT. <em>J Am Heart Assoc<\/em>. 2020; 9(21):e017330. Epub 2020 Oct 22.","source_url":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.120.017330","ices_scientist":[1146,1133,1385,1334,1140],"site":[6733],"research_program":[6742],"news_release":[],"journal_article":[],"atlas":[],"research_report":[],"infographic":[],"video":[],"downloads":null,"links":null,"sitecore_item_id":"84811860-DB52-4D00-94F8-EB9CB5758304","sitecore_item_name":"Use-of-cardiac-noninvasive-testing-after-emergency-department-discharge-association-of-hospital","sitecore_field_values":"{\n  \"Title\": \"Use of cardiac noninvasive testing after emergency department discharge: association of hospital network testing intensity and outcomes in Ontario, Canada\",\n  \"Short title\": \"Use of cardiac noninvasive testing\",\n  \"Summary\": \"We examined the relationship between hospital network noninvasive cardiac diagnostic testing and downstream clinical outcomes in patients discharged from the ED after assessment for chest pain.\",\n  \"Citation\": \"<p>Roifman I, Han L, Koh M, Wijeysundera HC, Austin PC, Douglas PS, Ko DT. <em>J Am Heart Assoc<\/em>. 2020; 9(21):e017330. Epub 2020 Oct 22. DOI: <a href=\"https:\/\/doi.org\/10.1161\/JAHA.120.017330\" title=\"Opens external link\">https:\/\/doi.org\/10.1161\/JAHA.120.017330<\/a><\/p>\",\n  \"Abstract\": \"<p><strong>Background <\/strong>&mdash; 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.<\/p>n<p><span class=\"bold\">Methods and Results <\/span>&mdash; 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\u2010cause mortality. Adjusted Cox proportional hazards models were used to compare the hazard of the composite outcome of myocardical infarction and\/or all\u2010cause 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 &gt;90 days (hazard ratio [HR], 1.00; 95% CI, 0.83&ndash;1.21), 6 months (HR, 1.07; 95% CI, 0.92&ndash;1.24), and 1 year (HR, 1.03; 95% CI, 0.94&ndash;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&ndash;1.19), 6 months (HR, 1.01; 95% CI, 0.87&ndash;1.17); and 1 year (HR, 0.95; 95% CI, 0.86&ndash;1.05).<\/p>n<p><strong>Conclusions <\/strong>&mdash; Our population\u2010based study demonstrated that high noninvasive cardiac diagnostic testing use intensity was not associated with reductions in downstream myocardial infarction or all\u2010cause mortality.<\/p>n<p><a href=\"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.120.017330\" title=\"Opens external link\">View full text<\/a><\/p>\",\n  \"Research Programs\": \"{BEC72DE0-BA8C-42B8-ACE5-EE29FFB2CB3B}\",\n  \"ICES Locations\": \"{4FCAABBA-14A5-42E6-8F33-BC6C2F1D9908}\",\n  \"ICES Scientists\": \"{B3827152-93D1-4FB2-B106-590CB331A264}|{8C2597F4-2B41-4E87-9F28-6887C689651B}|{7D498E8B-5801-4F9E-AC41-11ED50F3C34E}|{316AE4AB-993D-47C5-BFDA-B16D36BA7A0F}|{5347DD83-0742-46B5-B0AC-4EF2A329F89E}\",\n  \"Posted Date\": \"20201022T000000\",\n  \"Show on Publications Landing Page\": \"1\"\n}","previous_url":"https:\/\/www.ices.on.ca\/Publications\/Journal-Articles\/2020\/October\/Use-of-cardiac-noninvasive-testing-after-emergency-department-discharge-association-of-hospital"},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.1 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>ICES | Use of cardiac noninvasive testing after emergency department discharge: association of hospital network testing intensity and outcomes in Ontario, Canada<\/title>\n<meta name=\"description\" content=\"Background &#x2014; The relationship between noninvasive cardiac diagnostic testing intensity and downstream clinical outcomes is unclear. 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