Fabian Bamberg1,2, Thomas Mayrhofer3,4,5, Maros Ferencik3,6, Daniel O Bittner3,4,7, Travis R Hallett3,4, Sumbal Janjua3,4, Christopher L Schlett3, John T Nagurney8, James E Udelson9, Quynh A Truong10, Pamela K Woodard11, Judd E Hollander12, Harold Litt13, Udo Hoffmann3,14. 1. Cardiac MR PET CT Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. fabian.bamberg@uni-tuebingen.de. 2. Department of Diagnostic and Interventional Radiology, University of Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany. fabian.bamberg@uni-tuebingen.de. 3. Cardiac MR PET CT Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. 4. Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. 5. School of Business Studies, Stralsund University of Applied Science, Stralsund, Germany. 6. Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR, USA. 7. Department of Medicine 2 - Cardiology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), University Hospital Erlangen, Erlangen, Germany. 8. Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. 9. Division of Cardiology and the Cardio-Vascular Center, Tufts Medical Center, Boston, MA, USA. 10. Weill Cornell Medical College, New York, NY, USA. 11. Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA. 12. Department of Emergency Medicine, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA. 13. Department of Radiology and Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA. 14. Department of Diagnostic and Interventional Radiology, University of Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.
Abstract
OBJECTIVES: To determine resource utilisation according to age and gender-specific subgroups in two large randomized diagnostic trials. METHODS: We pooled patient-specific data from ACRIN-PA 4005 and ROMICAT II that enrolled subjects with acute chest pain at 14 US sites. Subjects were randomized between a standard work-up and a pathway utilizing cardiac computed tomography angiography (CCTA) and followed for the occurrence of acute coronary syndrome (ACS) and resource utilisation during index hospitalisation and 1-month follow-up. Study endpoints included diagnostic accuracy of CCTA for the detection of ACS as well as resource utilisation. RESULTS: Among 1240 patients who underwentCCTA, negative predictive value of CCTA to rule out ACS remained very high (≥99.4%). The proportion of patients undergoing additional diagnostic testing and cost increased with age for both sexes (p < 0.001), and was higher in men as compared to women older than 60 years (43.1% vs. 23.4% and $4559 ± 3382 vs. $3179 ± 2562, p < 0.01; respectively). Cost to rule out ACS was higher in men (p < 0.001) and significantly higher for patients older than 60 years ($2860-5935 in men, p < 0.001). CONCLUSIONS:CCTA strategy in patients with acute chest pain results in varying resource utilisation according to age and gender-specific subgroups, mandating improved selection for advanced imaging. KEY POINTS: • In this analysis, CAD and ACS increased with age and male gender. • CCTA in patients with acute chest pain results in varying resource utilisation. • Significant increase of diagnostic testing and cost with age for both sexes. • Cost to rule out ACS is higher in men and patients >60 years. • Improved selection of subjects for cardiac CTA result in more resource-driven implementation.
RCT Entities:
OBJECTIVES: To determine resource utilisation according to age and gender-specific subgroups in two large randomized diagnostic trials. METHODS: We pooled patient-specific data from ACRIN-PA 4005 and ROMICAT II that enrolled subjects with acute chest pain at 14 US sites. Subjects were randomized between a standard work-up and a pathway utilizing cardiac computed tomography angiography (CCTA) and followed for the occurrence of acute coronary syndrome (ACS) and resource utilisation during index hospitalisation and 1-month follow-up. Study endpoints included diagnostic accuracy of CCTA for the detection of ACS as well as resource utilisation. RESULTS: Among 1240 patients who underwent CCTA, negative predictive value of CCTA to rule out ACS remained very high (≥99.4%). The proportion of patients undergoing additional diagnostic testing and cost increased with age for both sexes (p < 0.001), and was higher in men as compared to women older than 60 years (43.1% vs. 23.4% and $4559 ± 3382 vs. $3179 ± 2562, p < 0.01; respectively). Cost to rule out ACS was higher in men (p < 0.001) and significantly higher for patients older than 60 years ($2860-5935 in men, p < 0.001). CONCLUSIONS:CCTA strategy in patients with acute chest pain results in varying resource utilisation according to age and gender-specific subgroups, mandating improved selection for advanced imaging. KEY POINTS: • In this analysis, CAD and ACS increased with age and male gender. • CCTA in patients with acute chest pain results in varying resource utilisation. • Significant increase of diagnostic testing and cost with age for both sexes. • Cost to rule out ACS is higher in men and patients >60 years. • Improved selection of subjects for cardiac CTA result in more resource-driven implementation.
Authors: Allen J Taylor; Manuel Cerqueira; John McB Hodgson; Daniel Mark; James Min; Patrick O'Gara; Geoffrey D Rubin Journal: Circulation Date: 2010-10-25 Impact factor: 29.690
Authors: Judd E Hollander; Andra L Blomkalns; Gerard X Brogan; Deborah B Diercks; John M Field; J Lee Garvey; W Brian Gibler; Timothy D Henry; James W Hoekstra; Brian R Holroyd; Yuling Hong; J Douglas Kirk; Brian J O'Neil; Raymond E Jackson; Tom Aufderheide; Andra L Blomkalns; Gerard X Brogan; James Christenson; Sean Collins; Deborah B Diercks; Francis M Fesmire; J Lee Garvey; Gary B Green; Christopher J Lindsell; W Frank Peacock; Charles V Pollack; Robert Zalenski Journal: Ann Emerg Med Date: 2004-12 Impact factor: 5.721
Authors: Harold I Litt; Constantine Gatsonis; Brad Snyder; Harjit Singh; Chadwick D Miller; Daniel W Entrikin; James M Leaming; Laurence J Gavin; Charissa B Pacella; Judd E Hollander Journal: N Engl J Med Date: 2012-03-26 Impact factor: 91.245
Authors: Maros Ferencik; Ting Liu; Thomas Mayrhofer; Stefan B Puchner; Michael T Lu; Pal Maurovich-Horvat; J Hector Pope; Quynh A Truong; James E Udelson; W Frank Peacock; Charles S White; Pamela K Woodard; Jerome L Fleg; John T Nagurney; James L Januzzi; Udo Hoffmann Journal: JACC Cardiovasc Imaging Date: 2015-10-14
Authors: Udo Hoffmann; John T Nagurney; Fabian Moselewski; Antonio Pena; Maros Ferencik; Claudia U Chae; Ricardo C Cury; Javed Butler; Suhny Abbara; David F Brown; Alex Manini; John H Nichols; Stephan Achenbach; Thomas J Brady Journal: Circulation Date: 2006-10-30 Impact factor: 29.690
Authors: Quynh A Truong; Douglas Hayden; Pamela K Woodard; Ruth Kirby; Eric T Chou; John T Nagurney; Stephen D Wiviott; Jerome L Fleg; David A Schoenfeld; James E Udelson; Udo Hoffmann Journal: Circulation Date: 2013-05-17 Impact factor: 29.690
Authors: Edward Hulten; Christopher Pickett; Marcio Sommer Bittencourt; Todd C Villines; Sara Petrillo; Marcelo F Di Carli; Ron Blankstein Journal: J Am Coll Cardiol Date: 2013-02-06 Impact factor: 24.094