Using cardiac CT in the emergency department to diagnose low risk patients with chest pain is 44 percent less expensive than the standard of care and can decrease the length of stay up to 20 hours, according to a study presented today in Boston at the 2009 annual meeting of the American Roentgen Ray Society (ARRS).
Researchers from the University of Washington in Seattle compared 53 low-risk chest pain patients by using results from a cardiac CT based workup and a traditional standard of care workup using nuclear stress testing. The current standard of care (SOC) workup of chest pain patients in an ED takes 12-36 hours and is expensive, according to the authors. They acknowledged that majority of low-risk chest pain patients in this setting do not have coronary artery disease.
"Nothing was cut from the standard of care workup," said the study's lead author Janet May, MS, who worked with William Shuman, MD.
"The current ED standard of care workup for low-risk chest pain patients often involves serial cardiac enzymes, serial ECGs and a nuclear cardiac stress test. Such a workup can take up to 30 hours and is expensive. The mean cost for the SOC workup in this study was $7,597," May reported. "With new lower dose cardiac CT options available that lower the patient radiation dose, patients get a faster evaluation and are discharged much sooner with a cardiac CT; in less than six hours," she said.
"Once you know the case is a low risk patient with chest pain, the sooner the cardiac CT is done, the better. Speed results in cost savings without compromising accuracy," said May.
The researchers found that in this population of low-risk ED chest pain patients, discharge based on negative cardiac CT angiography, negative cardiac enzymes and negative ECG may significantly decrease both length of stay and hospital charges compared to SOC.
"Emergency rooms across the nation are struggling with congestion and escalating cost issues. Over six million patients present to U.S. emergency rooms each year with chest pain and the majority of these are low risk. Dealing with these patients faster and with greater cost effectiveness is a big step toward ameliorating congestion and spiraling cost," she said.