Millions of dollars in unnecessary cardiac stress tests could be avoided if emergency room patients with chest pain were better informed about their treatment options, according to a new study by the Mayo Clinic. Over 6 million people go to emergency rooms every year complaining of chest pain, resulting in $8 billion dollars annually in health care costs.
“To avoid missing a diagnosis of heart attack, which could have substantial medical and legal implications, emergency physicians often admit patients to observation units for stress testing, even though patients are at a very low risk for heart attack,” says lead author Erik Hess, MD, an emergency room physician at the Mayo Clinic. “This results in false-positive test results, unnecessary additional procedures, exposure to radiation and increased cost.”
“If we were to decrease our rate of patients being admitted into the observation unit for stress testing by 20 percent, this would likely translate into millions of dollars in savings,” says Hess.
For the study, Mayo Clinic researchers gave over 200 chest pain patients who were at low risk of a heart attack counseling through a so-called “decision aid” — a tool that summarized and educated patients about their treatment. The decision aid included the initial diagnosis, the patient’s personal risk for heart attack and a menu of further treatment options — ranging from admission to the hospital and an urgent cardiac stress test to making an appointment with their primary care doctor within 72 hours. Patients in the study were followed for the next 30 days and experienced no acute heart problems after leaving the hospital.
“We found that low-risk chest pain patients who participated in shared decision making often chose less extensive testing once it was clear that they weren’t having a heart attack,” says co-author Victor Montori, MD, director of the Mayo Clinic’s Center for the Science of Health Care Delivery.
“As physicians we all recognize that heart attacks are a bad thing and you wouldn’t want to miss it. And it’s our natural desire to keep the patient safe. So even if there was a very small risk, we’ll often test almost everyone,” explained Hess. “But it’s the patient’s life. And it’s really their choice.”
Patients who were counseled with a decision aid about their treatment options decided to be admitted for stress testing 58 percent of the time, compared to 77 percent who were not counseled. Counseled patients were also significantly more knowledgeable about their risk of a heart attack.
“Using a decision aid to discuss evaluation options appears to improve patients’ understanding of their condition,” Dr. Hess says. “In addition, patients who used the decision aid chose less expensive evaluation options and reported greater satisfaction with the decision-making process.”