Abstract 14986: Nationwide Hospital Variation in the Use and Outcomes of Cardiac Stress Testing in Patients Presenting to the Emergency Department

• Published in: Circulation (New York, N.Y.) Vol. 134; no. Suppl_1 Suppl 1; p. A14986
• Main Authors: Mudrick, Daniel W, Vemulapalli, Sreekanth, Houle, Christy R, Kristy, Rita, Spalding, James R, Magee, Glenn, Davis, Teresa, Lee, Edward, Taylor, Durran, Kitt, Therese M
• Format: Journal Article
• Language: English
• Published: by the American College of Cardiology Foundation and the American Heart Association, Inc 11-11-2016
• ISSN: 0009-7322; 1524-4539

IntroductionHospitals vary significantly in rates of cardiac testing during initial evaluation of chest pain in the ED. This study examines hospital rates of cardiac re-testing and cardiac-related readmission 180 days post-discharge in a large national database (Premier).MethodsInitial inpatient and outpatient discharges between January 2009 and December 2014 were identified for patients 35 years or older first evaluated in the ED with a diagnosis consistent with acute coronary syndrome risk and cardiac biomarker testing. Patients were categorized based on occurrence of any noninvasive cardiac testing during their index visit and were summarized at the hospital level as a percentage. The highest (HQ) and lowest (LQ) quartiles of hospitals for both inpatient and outpatient encounters were identified based on the percentage of patients receiving any cardiac test (FIG). Multivariate models assessed the risk of cardiac re-testing and cardiac readmission within 180 days from index discharge.ResultsThere were 531 evaluable hospitals (134 each in HQ and LQ). Unadjusted mean rates of additional cardiac testing and cardiac readmissions were higher for HQ hospitals (FIG).In the multivariate analyses, adjusting for hospital characteristics and case mix among inpatients, the HQ hospitals had a higher likelihood of cardiac re-testing (2.25, p <0.001) and cardiac readmission (1.16, p <=0.022) as compared to LQ hospitals. Similarly, among outpatients, HQ hospitals also had higher rates of cardiac re-testing (2.01, p <0.001) and cardiac readmission (1.40, p <0.001).ConclusionAfter adjustment, hospitals with the highest rates of initial testing have higher rates of cardiac re-testing and cardiac-related readmissions compared to the lowest testing hospitals. Additional research is required to determine if these differences are influenced by hospital protocols, available testing-related resources or other factors not captured in this analysis.