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Long-term
study results validate efficacy of CT Scans
for Chest Pain Diagnosis
Newswise — The first long-term study
following a large number of chest pain
patients who are screened with coronary
computerized tomographic angiography (CTA)
confirms that the test is a safe, effective
way to rule out serious cardiovascular
disease in patients who come to hospital
emergency rooms with chest pain, according
to new research from the University of
Pennsylvania School of Medicine which was
presented Friday, May 15, 2009 at the
Society for Academic Emergency Medicine’s
annual conference.
Chest pain is a common and costly health
complaint in the United States, bringing 8
million Americans to hospital emergency
departments each year.
Although just five to 15 percent of those
patients are found to be suffering from
heart attacks or other cardiac diseases,
more than half are admitted to the hospital
for observation and further testing.
CTA streamlines the process and provides a
faster, and less expensive way to evaluate
which patients have an acute coronary
syndrome that require treatment.
“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,” says lead author Judd
Hollander, MD, professor and clinical
research director in Penn’s department of
Emergency Medicine. “The use of this test is
a win-win.”
Among patients enrolled in the trial after
getting a negative scan – a scan showing no
evidence of dangerous blockages in the
coronary arteries – 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 say the findings provide a
roadmap for how to appropriately and
cost-effectively use this advanced imaging
technology, which generates lifelike,
three-dimensional photos of the heart and
the matrix of blood vessels that surround
it.
Investigators followed 481 patients who
received negative CTA scans for one year
after their hospital visit. The patients
studied had a mean age of 46.
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 Penn research has shown that CTA 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 CTA
in the emergency department 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 CTA helps get
patients home faster, since patients who
received immediate CTA were discharged after
an average of eight hours, compared to stays
that exceeded 24 hours for those who were
admitted for scheduled testing and
monitoring.
Despite the mounting evidence that CTA
provides cost savings, it remains unclear
whether Medicare or any individual insurer
will cover the tests in an emergency
department setting.
A ruling from the Centers for Medicare and
Medicaid Services in the spring of 2008 laid
out a specific, narrow set of circumstances
under which coronary CTA costs would be
reimbursed, but some physicians are
continuing to lobby for a re-examination of
the issue given the increasing pressure to
cut health care costs and increase emergency
department 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 says.
“It seems time to make a national coverage
decision that will facilitate coronary CTA
in the emergency department.”
PENN Medicine is a $3.6 billion enterprise
dedicated to the related missions of medical
education, biomedical research, and
excellence in patient care.
PENN Medicine consists of the University of
Pennsylvania School of Medicine (founded in
1765 as the nation's first medical school)
and the University of Pennsylvania Health
System.
Penn's School of Medicine is currently
ranked #3 in the nation in U.S.News & World
Report's survey of top research-oriented
medical schools; and, according to the
National Institutes of Health, received over
$366 million in NIH grants (excluding
contracts) in the 2008 fiscal year.
Supporting 1,700 fulltime faculty and 700
students, the School of Medicine is
recognized worldwide for its superior
education and training of the next
generation of physician-scientists and
leaders of academic medicine.
The University of Pennsylvania Health System
(UPHS) includes its flagship hospital, the
Hospital of the University of Pennsylvania,
rated one of the nation’s top ten “Honor
Roll” hospitals by U.S.News & World Report;
Pennsylvania Hospital, the nation's first
hospital; and Penn Presbyterian Medical
Center, named one of the nation’s “100 Top
Hospitals” for cardiovascular care by
Thomson Reuters.
In addition UPHS includes a primary-care
provider network; a faculty practice plan;
home care, hospice, and nursing home; three
multispecialty satellite facilities; as well
as the Penn Medicine at Rittenhouse campus,
which offers comprehensive inpatient
rehabilitation facilities and outpatient
services in multiple specialties.
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