A computer imaging scan can tell doctors which patients with heart attack symptoms are fine and can be sent home from the emergency room, avoiding extra stays for evaluation, according to a study.
Most patients who visit a hospital with classic signs of heart attack are given a battery of tests and admitted for observation, only to be discharged a day later. A coronary computed tomographic angiography, or CT scan, can weed out the patients who aren’t at risk, avoiding stays, according to the study released today in the New England Journal of Medicine.
The scan “appears to allow the safe, expedited discharge from the emergency department of many patients who would otherwise be admitted,” the researchers wrote.
The use of such scans has been criticized by some as too costly as well as potentially dangerous. The U.S. government has reduced reimbursement by $6 billion since 2007 in its health programs to quash rising costs and incentives to prescribe unnecessary tests.
Patients who arrive at the emergency room with chest pains usually undergo a variety of tests, some that cost more than a CT scan, said Harold Litt, an author of the study and associate professor of radiology at the University of Pennsylvania.
While the average cost of chest CT angiographies is $5,400, a stress test traditionally done for heart pain costs $3,800 and patients with cardiac distress are usually kept at least an extra day for observation. The average price of a one-day stay was $1,920 in 2010, according to Marie Watteau, a spokeswoman for the Washington-based American Hospital Association.
“In terms of direct costs, a CT scan is fairly competitive,” Litt said by telephone “If you can get out of the emergency department faster, if you don’t have to be admitted to the hospital -- those things will decrease costs.”
Heart disease is the leading cause of death in the U.S., and more than 1 million Americans have a heart attack every year, according to the U.S. Centers for Disease Control.
The research segmented two groups of patients, 908 who received CT scans, and 462 treated traditionally. The patients in the CT scan group were kept at the hospital for a median of six hours fewer than the other group and had a higher discharge rate. None of the patients died or suffered a heart attack within 30 days following the scan, the study found.
Discharging patients not in danger of having a heart attack quicker lets hospitals turn their attention to patients in need, Litt said. The savings from that as well as avoiding other types of scans or tests would be significant, he said.
The amount of radiation patients receive is also comparable, if not less than competing scans, Litt said.
“Yes, there is a radiation dose, but it’s been dramatically decreased over the past couple of years,” he said.
The study was sponsored by the Commonwealth of Pennsylvania Department of Health and the American College of Radiology Imaging Network Foundation.
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