Cardiovascular Business - September/October 2008 - (Page 35) or sign-up for our weekly newsletter @ Subs.CardiovascularBusiness.com Get a daily dose of Cardiovascular Business News, visit CardiovascularBusiness.com, á Outpatient chest pain triage with CTA reduces downstream costs Army Medical Center. In a blinded study, Patrick J. Devine, MD, and colleagues asked two general cardiologists to review the following information for 75 patients who had undergone ther functional or anatomic evaluation. Based on the cardiologists’ assessment, researchers determined that a CTA-based triage strategy significantly reduced stress tests and/or caths (58 vs. 11). Furthermore, it resulted in significantly fewer unnecessary caths (23 vs. 6). The study appeared in the July/August issue of the Journal of Cardiovascular Computed Tomography. “The majority of these lowto intermediate-risk patients in our study were referred to CCTA due to either non-diagnostic stress tests or ongoing worrisome symptoms despite a normal stress test,” says coauthor Todd C. Villines, MD, co-director of cardiac CT. “This was done to avoid invasive catheterization given the non-convincing nature of the symptoms, the stress test abnormality, or both.” In another study, Rahul Khare, MD, and colleagues at Northwestern Memorial Hospital in Chicago found that a CT-based triage also results in cost savings for low-risk patients with chest pain in the emergency department. Researchers utilized a computer model to analyze the cost-effectiveness of CCTA for a standard 54-year-old male patient within three risk categories: very low, low, and moderate (Acad Emerg Med2008;7;623-632). For each group, the cost of using a CT scan was lower than the cost of an observation unit stay and stress testing. Furthermore, the qualityadjusted life years were higher. “There is good evidence that the use of this technology will be the standard of care in the future, and we must determine if the benefit will outweigh the cost. This study shows that it does, and more importantly, that it may even be cost-saving in certain situations,” Khare says. By C.P. Kaiser L ess than 2 percent of all outpatient physician visits each year are for chest pain and less than 20 percent of these cases are due to coronary artery disease (CAD). Curved multiplanar reconstruction of the left anterior descending artery (Lad) shows a classic appearance of a mixed plaque (calcified and non-calcified) that, while not obstructive, is well visualized on Ct in the proximal Lad. source: todd C. Villines, Md, Walter reed army Medical Center Yet, the multiple stress tests and unnecessary coronary angiographies that occur in this setting represent 10 percent of the $274 billion annual cost of cardiovascular services in the U.S. (Circulation 2007;115:169-171). Clearing low- to intermediate-risk patients of significant CAD with coronary CT angiography (CCTA) would reduce the current economic burden that this patient population puts on the healthcare system, according to researchers at Walter Reed CCTA for angina: subject age, nature of anginal symptom, known cardiac risk factors, calculated Framingham Risk Score, pretest probability of obstructive coronary artery disease and results of any previous ischemic evaluations. The cardiologists were then asked to recommend their next single clinical course of action, excluding CCTA. These choices included traditional catheter angiography, stress echo or SPECT, graded exercise treadmill test, or no fur- Errata • in our cover story for May/ June: Coronary Cta: drafting the strategic Plan, page 6, we incorrectly identified the location of the sanford usd Medical Center. it is located in sioux Falls, s.d. • the article “eCG image Management Brings increased Productivity and Confidence,” published in July/august, page 18, incorrectly states where Kelly neal works. she is the director of cardiovascular services at Washington Hospital in Washington, Penn. the Washington Hospital Center in Washington, d.C., uses Ge diagnostic cardiology equipment. CardiovascularBusiness.com Cardiovascular Business 33 http://CardiovascularBusiness.com http://Subs.CardiovascularBusiness.com http://CardiovascularBusiness.com
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