SAEM: CCTA delivers speedy, economical ED chest pain diagnosis
"The ability to rapidly determine that there is nothing seriously wrong allows us to provide reassurance to the patient and to help reduce crowding in the emergency department," said lead author Judd Hollander, MD, professor and clinical research director in University of Pennsylvania School of Medicine department of emergency medicine in Philadelphia. "The use of this test is a win-win."
Among patients enrolled in the trial after getting a negative scan, no patients in the study had heart attacks or required bypass surgery or placement of cardiac stents in the year following their test. The authors said that the findings provide a roadmap for how to appropriately and cost-effectively use this advanced imaging technology.
The researchers followed 481 patients (mean age, 46), who had received negative CCTA scans, for one year after their hospital visit. While 11 percent of patients were rehospitalized and 11 percent received additional cardiac testing--stress tests or cardiac catheterizations--over the following year, none had heart attacks or needed revascularization procedures to prop open blocked coronary arteries. One patient in the study died of an unrelated cause during the year.
Previous University of Pennsylvania research has shown that CCTA is both a quicker and less expensive way to screen low-risk chest pain patients than conventional testing methods. Costs for patients who receive immediate CCTA in the ED average about $1,500, while costs for patients admitted to the hospital for stress testing and telemetry monitoring total more than $4,000 for each patient. Those studies also showed that CCTA helps get patients home faster, since patients who received immediate CCTA were discharged after an average of eight hours, compared with stays that exceeded 24 hours for those who were admitted for scheduled testing and monitoring.
Despite the mounting evidence that CCTA provides cost savings, it remains unclear whether Medicare or any individual insurer will cover the tests in an ED setting, according to the authors.
A ruling from the Centers for Medicare & Medicaid Services (CMS) in the spring of 2008 laid out a specific, narrow set of circumstances under which CCTA costs would be reimbursed, but some physicians are continuing to lobby for a re-examination of the issue given the increasing pressure to cut healthcare costs and increase ED efficiency.
"The evidence now clearly shows that when used in appropriate patients in the ED, we can safely and rapidly reduce hospital admission and save money," Hollander said. "It seems time to make a national coverage decision that will facilitate CCTA in the ED."