AJR: Cardiac CT reduces costs, hospital stay for low-risk patients with chest pain

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The use of cardiac CT for low-risk chest pain patients in the emergency department--instead of the traditional standard-of-care (SOC) workup--may reduce a patient's length of stay and hospital charges, according to a single-center study in the July issue of the American Journal of Roentgenology.

The SOC workup consists of a series of cardiac enzyme tests, ECGs and nuclear stress testing in an emergency department, which takes 12-36 hours and is expensive, according to the authors. After informed consent, the researchers added cardiac CT early in the SOC workup of 53 consecutive patients. Fifty patients had negative CT findings and were included in this series.

The investigators analyzed the length of stay and charges using actual patient data for all patients in the SOC workup and for two earlier discharge scenarios based on negative cardiac CT results: First, CT plus serial enzyme tests and ECGs during an observation period followed by discharge if all were negative; and second, CT plus one set of enzyme tests and one ECG followed by discharge if all were negative.

"We found that cardiac CT based workups in low-risk chest pain patients decreased the length of hospital stay up to 20 hours and was significantly cheaper (44 percent less) than using the standard-of-care workup," said the study's lead author, Janet May, from the University of Washington School of Medicine in Seattle.

"The SOC mean length of stay was 25.4 hours and the mean length of stay for cardiac CT with observation was 14.3 hours," May said. "The mean charges for SOC were $7,597; the mean charges for cardiac CT with observation were $6,153; and the mean charges for cardiac CT without observation were $4,251."

"Delivering care through emergency departments is expensive, so cost containment in that setting is critical. Over six million patients present to U.S. emergency rooms each year with chest pain and up to 79 percent of those patients fall into the low-risk category," she said.

"Our study shows that cardiac CT has the potential to significantly reduce cost and length of stay in the emergency department by rapidly identifying those patients who can safely be discharged quickly," May stated.