When parceling the analysis to deal with sub-groups broken down by age, sex, race, or clinical history, and whether they had serious procedures like revascularizations done, the median savings for the MRI group remained, which saw an increase in median revenue of about $655 per patient.

Importantly, screening the patients in the observation unit wasn't associated with missing serious ailments down the road. No one discharged in any group had a serious heart problem a month after discharge, the researchers said.


CONSERVING INPATIENT RESOURCES

So, where did the savings come from? Most appeared to come from savings on inpatient resources, such as nursing time, equipment charges and overhead for the floor, Miller said.

And while numbers of patients getting cardiac catheterization weren't significantly different, patients in the MRI group had slightly shorter hospital stays: about 26 hours, as opposed to the nearly 30 hours for the inpatient group.

Still, it's possibly too early to tell how much money the hospitals really saved. Although patients were randomly selected to be in each group, the patients in the inpatient group appeared, by chance, to have slightly more heart problems.

Of the inpatient group, six of 57 had a serious heart problem, while two out of 53 in the MRI group did.

More important, the study didn't factor in the sometimes immense up-front costs of purchasing and installing a cardiac MRI machine, and paying for staff to operate it.

"If you're looking to support a cardiac MRI just through the patients managed in an observation unit, that would be a tough proposition," Miller said. Although data are sparse, Miller said some estimate a cardiac MRI unit would have to have volumes of 1,500 to 2,000 scans per year -- more than an observation unit would generate.

"An effective cardiac MRI program would have to be integrated with patients coming from other sources other than the observation unit," Miller said.

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