Efficacy Of CT Scans For Chest Pain Diagnosis Validated By Long-Term Study Results
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The head long-term study closest a big number of chest heartache patients who are screened with coronary computerized tomographic angiography (CTA) confirms that the investigation is a safe, effective road 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 Academy 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 infirmary emergency departments everyone year. Although just five to 15 percent of those patients are inaugurate to be suffering from affection attacks or other cardiac diseases, more than half are admitted to the infirmary for observation and as well testing. CTA streamlines the process and provides a faster, and less expensive way to evaluate which patients have an acute coronary syndrome that wish treatment.
"The comprehension to rapidly impel that there is bagatelle seriously fault allows us to provide reassurance to the patient and to balm reduce crowding in the emergency department," says lead author Judd Hollander, MD, professor and clinical test director in Penn's branch of Emergency Medicine. "The use of this evaluation is a win-win."
Among patients enrolled in the check after getting a antagonistic recite - a glance at showing no evidence of dangerous blockages in the coronary arteries - no patients in the discover had heart attacks or required bypass surgery or placement of cardiac stents in the year succeeding their test. The authors divulge the findings administer 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 extra cardiac testing - stress tests or cardiac catheterizations - over the adjacent year, none had heart attacks or needed revascularization procedures to prop frank blocked coronary arteries. One patient in the recite died of an unrelated effect during the year.
Previous Penn research has shown that CTA is both a quicker and less expensive course to shade low-risk chest malaise patients than conventional testing methods. Costs for patients who arrogate instant CTA in the emergency department sample about $1,500, while costs for patients admitted to the hospital for stress testing and telemetry monitoring total expanded than $4,000 for each patient. Those studies also showed that CTA helps move patients home faster, since patients who received immediate CTA were discharged after an morals of eight hours, compared to stays that exceeded 24 hours for those who were admitted for scheduled testing and monitoring.
In spite of the mounting evidence that CTA provides valuation savings, it remains unclear if Medicare or any individual insurer testament cover the tests in an emergency department setting.
A ruling from the Centres for Medicare and Medicaid Services in the spring of 2008 laid out a specific, narrow fix of circumstances under which coronary CTA costs would be reimbursed, but some physicians are continuing to foyer for a re-examination of the issue inclined the increasing pressure to decrease health keeping costs and burgeoning emergency department efficiency.
"The evidence double time clearly shows that when used in appropriate patients in the ED, we can safely and rapidly shorten hospital admission and save money," Hollander says. "It seems time to cook a national coverage decision that will facilitate coronary CTA in the emergency department."
University of Pennsylvania College of Medicine
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