{"id":5614,"date":"2019-11-05T00:00:00","date_gmt":"2019-11-05T05:00:00","guid":{"rendered":"https:\/\/icesontario.wpengine.com\/journal-articles\/clinical-effectiveness-of-cardiac-noninvasive-diagnostic-testing-in-patients-discharged-from-the-emergency-department-for-chest-pain\/"},"modified":"2023-06-14T19:30:02","modified_gmt":"2023-06-14T23:30:02","slug":"clinical-effectiveness-of-cardiac-noninvasive-diagnostic-testing-in-patients-discharged-from-the-emergency-department-for-chest-pain","status":"publish","type":"journal_article","link":"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/clinical-effectiveness-of-cardiac-noninvasive-diagnostic-testing-in-patients-discharged-from-the-emergency-department-for-chest-pain\/","title":{"rendered":"Clinical effectiveness of cardiac noninvasive diagnostic testing in patients discharged from the emergency department for chest pain"},"content":{"rendered":"<p><strong>Background<\/strong> &#x2014; More than 4 million cardiac noninvasive diagnostic tests are performed annually in the United States. However, questions remain regarding their effectiveness in improving clinical outcomes. We sought to evaluate whether noninvasive diagnostic tests were associated with lower rates of myocardial infarction or cardiovascular death when compared with no testing.<\/p>\n<p><span class=\"bold\">Methods and Results<\/span> &#x2014; We performed a retrospective, population&#x2010;based cohort study of adults evaluated for chest pain and discharged home from an emergency department in Ontario, Canada. Propensity score matching was employed to reduce confounding between the testing and nontesting groups. There were 370 863 patients evaluated in our cohort. Rates of the composite outcome were low for both groups after propensity&#x2010;score matching (0.29% and 0.78% for the nontesting group at 90&#xa0;days and 1 year, respectively, and 0.34% and 0.68% for the noninvasive diagnostic test group at 90 days and 1 year respectively). Over 1 year, patients undergoing noninvasive diagnostic testing had a small but statistically significant lower hazard of developing the composite outcome of myocardial infarction or cardiovascular mortality (hazard ratio, 0.87; 95% CI, 0.78&#x2013;0.96 [<em>P<\/em>&lt;0.01]), which appears to be driven by the high&#x2010;risk subgroup (hazard ratio, 0.75; 95% CI, 0.61&#x2013;0.92 [<em>P<\/em>&lt;0.01]).<\/p>\n<p><strong>Conclusion<\/strong> &#x2014; We report a lower observed rate of the composite outcome of cardiovascular death or myocardial infarction associated with noninvasive diagnostic testing following evaluation for chest pain in the emergency department. This lower rate was driven by the high&#x2010;risk subgroup. These results suggest that risk&#x2010;based testing should be considered for patients discharged from the emergency department for chest pain.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Background &#x2014; More than 4 million cardiac noninvasive diagnostic tests are performed annually in the United States. However, questions remain regarding their effectiveness in improving clinical outcomes. We sought to evaluate whether noninvasive diagnostic tests were associated with lower rates of myocardial infarction or cardiovascular death when compared with no testing. Methods and Results &#x2014; [&hellip;]<\/p>\n","protected":false},"template":"","migration-helper-automated":[],"migration-manual":[],"topic":[],"migration-helper-qa-sample-set":[],"class_list":["post-5614","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> 2019; 8(21):e013824. Epub 2019 Nov 5.","source_url":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.119.013824","ices_scientist":[1334,1133,1146,1385],"site":[6733],"research_program":[6742],"news_release":[7973],"journal_article":[],"atlas":[],"research_report":[],"infographic":[],"video":[],"downloads":null,"links":null,"sitecore_item_id":"494F368B-7CE6-4F49-925E-3633BD03E802","sitecore_item_name":"Clinical-effectiveness-of-cardiac-non-invasive-diagnostic-testing-in-patients-discharged","sitecore_field_values":"{\n  \"__Valid from\": \"20191105T130828\",\n  \"Title\": \"Clinical effectiveness of cardiac noninvasive diagnostic testing in patients discharged from the emergency department for chest pain\",\n  \"Short title\": \"Clinical effectiveness of cardiac\",\n  \"Summary\": \"More than four million cardiac non-invasive diagnostic tests (NIT) are performed annually in the United States. However, questions remain regarding their effectiveness in improving clinical outcomes.\",\n  \"Citation\": \"<p>Roifman I, Han L, Koh M, Wijeysundera HC, Austin PC, Douglas PS, Ko DT. <em>J Am Heart Assoc.<\/em> 2019; 8(21):e013824. Epub 2019 Nov 5. DOI: <a href=\"https:\/\/doi.org\/10.1161\/JAHA.119.013824\" title=\"opens external link\">https:\/\/doi.org\/10.1161\/JAHA.119.013824<\/a><\/p>\",\n  \"Abstract\": \"<p><strong>Background<\/strong> &mdash; More than 4 million cardiac noninvasive diagnostic tests are performed annually in the United States. However, questions remain regarding their effectiveness in improving clinical outcomes. We sought to evaluate whether noninvasive diagnostic tests were associated with lower rates of myocardial infarction or cardiovascular death when compared with no testing.<\/p>n<p><span class=\"bold\">Methods and Results<\/span> &mdash; We performed a retrospective, population\u2010based cohort study of adults evaluated for chest pain and discharged home from an emergency department in Ontario, Canada. Propensity score matching was employed to reduce confounding between the testing and nontesting groups. There were 370 863 patients evaluated in our cohort. Rates of the composite outcome were low for both groups after propensity\u2010score matching (0.29% and 0.78% for the nontesting group at 90&nbsp;days and 1 year, respectively, and 0.34% and 0.68% for the noninvasive diagnostic test group at 90 days and 1 year respectively). Over 1 year, patients undergoing noninvasive diagnostic testing had a small but statistically significant lower hazard of developing the composite outcome of myocardial infarction or cardiovascular mortality (hazard ratio, 0.87; 95% CI, 0.78&ndash;0.96 [<em>P<\/em>&lt;0.01]), which appears to be driven by the high\u2010risk subgroup (hazard ratio, 0.75; 95% CI, 0.61&ndash;0.92 [<em>P<\/em>&lt;0.01]).<\/p>n<p><strong>Conclusion<\/strong> &mdash; We report a lower observed rate of the composite outcome of cardiovascular death or myocardial infarction associated with noninvasive diagnostic testing following evaluation for chest pain in the emergency department. This lower rate was driven by the high\u2010risk subgroup. These results suggest that risk\u2010based testing should be considered for patients discharged from the emergency department for chest pain.<\/p>n<p><a href=\"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.119.013824\" 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\": \"{316AE4AB-993D-47C5-BFDA-B16D36BA7A0F}|{8C2597F4-2B41-4E87-9F28-6887C689651B}|{B3827152-93D1-4FB2-B106-590CB331A264}|{7D498E8B-5801-4F9E-AC41-11ED50F3C34E}\",\n  \"Posted Date\": \"20191105T000000\",\n  \"Show on Publications Landing Page\": \"1\",\n  \"In The News\": \"{E02CD2FA-445A-462F-BF09-AA07EF0BB7E3}\"\n}","previous_url":"https:\/\/www.ices.on.ca\/Publications\/Journal-Articles\/2019\/November\/Clinical-effectiveness-of-cardiac-non-invasive-diagnostic-testing-in-patients-discharged"},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.8 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>ICES | Clinical effectiveness of cardiac noninvasive diagnostic testing in patients discharged from the emergency department for chest pain<\/title>\n<meta name=\"description\" content=\"Background &#x2014; More than 4 million cardiac noninvasive diagnostic tests are performed annually in the United States. 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