Cardiac testing choices by physician specialty in the CMR-IMPACT trial.

Authors

Michael W Supples
Anna C Snavely
Nicklaus P Ashburn
Lauren E Koehler
Jason P Stopyra
Carolyn J Park
Sujethra Vasu
Michael Kutcher
Gregory Hundley
Carol L. Clark, Corewell Health East

Document Type

Article

Publication Date

4-2025

Publication Title

The American journal of emergency medicine

Abstract

BACKGROUND: Heterogeneity is observed in the care of patients with chest pain. We investigate the association of physician specialty and diagnostic testing among patients admitted for suspected acute coronary syndrome (ACS).

METHODS: This is a secondary analysis of the CMR-IMPACT multicenter randomized controlled trial in which patients with suspected ACS were admitted and randomized to undergo invasive angiography or non-invasive CMR stress imaging. Admitting physician was dichotomized to interventional cardiologist (IC) or not (e.g. hospitalist). We describe adherence to protocol and angiography during the index visit by treatment arm and admitting physician specialty. A generalized estimating equation accounting for clustering within physician was used to evaluate significance and adjusted for randomization arm.

RESULTS: The 258 enrolled patients from 2013 to 2018 had a mean age of 60.7 (SD ± 10.9) years, 40.3 % (104/258 were female), and 64.7 % (167/258) were white race. ICs were the admitting physicians for 50.4 % (130/258) of the patients. Index angiography was performed more often among patients admitted by IC versus other physicians, 65.4 % (85/130) versus 53.1 % (68/128), respectively; aOR 1.75 (95 % CI 1.14-2.68). Among patients randomized to an invasive strategy, higher protocol adherence was observed in those admitted by IC [85.3 % (58/68)] versus other physicians [64.5 % (40/62)]; OR 2.82 (95 % CI 1.08-7.38). For patients randomized to the CMR-based strategy, adherence to protocol was similar for IC [67.7 % (42/62)] and other physicians [66.7 % (44/66)]; OR 0.82 (95 % CI 0.35-1.94).

CONCLUSION: Invasive angiography was more frequent among patients admitted by interventional cardiologists compared to other physicians.

Volume

90

First Page

200

Last Page

204

Recommended Citation

Supples MW, Snavely AC, Ashburn NP, Koehler LE, Stopyra JP, Park CJ, et al [Clark CL] Cardiac testing choices by physician specialty in the CMR-IMPACT trial. Am J Emerg Med. 2025 Apr;90:200-204. doi: 10.1016/j.ajem.2025.01.073. PMID: 39908686.

DOI

10.1016/j.ajem.2025.01.073

ISSN

1532-8171

PubMed ID

39908686