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Timmis A, Aboyans V, Vardas P, Townsend N, Torbica A, Kavousi M, Boriani G, Huculeci R, Kazakiewicz D, Scherr D, Karagiannidis E, Cvijic M, Kapłon-Cieślicka A, Ignatiuk B, Raatikainen P, De Smedt D, Wood A, Dudek D, Van Belle E, Weidinger F. European Society of Cardiology: the 2023 Atlas of Cardiovascular Disease Statistics. Eur Heart J 2024:ehae466. [PMID: 39189413 DOI: 10.1093/eurheartj/ehae466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 05/22/2024] [Accepted: 07/03/2024] [Indexed: 08/28/2024] Open
Abstract
This report from the European Society of Cardiology (ESC) Atlas Project updates and expands upon the 2021 report in presenting cardiovascular disease (CVD) statistics for the ESC member countries. This paper examines inequalities in cardiovascular healthcare and outcomes in ESC member countries utilizing mortality and risk factor data from the World Health Organization and the Global Burden of Disease study with additional economic data from the World Bank. Cardiovascular healthcare data were collected by questionnaire circulated to the national cardiac societies of ESC member countries. Statistics pertaining to 2022, or latest available year, are presented. New material in this report includes contemporary estimates of the economic burden of CVD and mortality statistics for a range of CVD phenotypes. CVD accounts for 11% of the EU's total healthcare expenditure. It remains the most common cause of death in ESC member countries with over 3 million deaths per year. Proportionately more deaths from CVD occur in middle-income compared with high-income countries in both females (53% vs. 34%) and males (46% vs. 30%). Between 1990 and 2021, median age-standardized mortality rates (ASMRs) for CVD decreased by median >50% in high-income ESC member countries but in middle-income countries the median decrease was <12%. These inequalities between middle- and high-income ESC member countries likely reflect heterogeneous exposures to a range of environmental, socioeconomic, and clinical risk factors. The 2023 survey suggests that treatment factors may also contribute with middle-income countries reporting lower rates per million of percutaneous coronary intervention (1355 vs. 2330), transcatheter aortic valve implantation (4.0 vs. 153.4) and pacemaker implantation (147.0 vs. 831.9) compared with high-income countries. The ESC Atlas 2023 report shows continuing inequalities in the epidemiology and management of CVD between middle-income and high-income ESC member countries. These inequalities are exemplified by the changes in CVD ASMRs during the last 30 years. In the high-income ESC member countries, ASMRs have been in steep decline during this period but in the middle-income countries declines have been very small. There is now an important need for targeted action to reduce the burden of CVD, particularly in those countries where the burden is greatest.
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Affiliation(s)
- Adam Timmis
- The William Harvey Research Institute, Queen Mary University London, London E1 4NS, UK
| | - Victor Aboyans
- Department of Cardiology, Dupuytren University Hospital, and EpiMaCT, Inserm 1098/IRD270, Limoges University, Limoges, France
| | - Panos Vardas
- Biomedical Research Foundation Academy of Athens and Hygeia Hospitals Group, HHG, Athens, Greece
- European Society of Cardiology, European Heart Agency, European Heart Health Institute, Brussels, Belgium
| | - Nick Townsend
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol BS8 1TZ, UK
| | - Aleksandra Torbica
- Centre for Research on Health and Social Care Management (CERGAS), Bocconi University, Milan, Italy
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Radu Huculeci
- European Society of Cardiology, European Heart Agency, European Heart Health Institute, Brussels, Belgium
| | - Denis Kazakiewicz
- European Society of Cardiology, European Heart Agency, European Heart Health Institute, Brussels, Belgium
| | - Daniel Scherr
- Division of Cardiology, Medical University of Graz, Graz, Austria
| | - Efstratios Karagiannidis
- Second Department of Cardiology, General Hospital 'Hippokration', Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Marta Cvijic
- Department of Cardiology, University Medical Centre Ljubljana, and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | | | - Barbara Ignatiuk
- Department of Cardiology, Humanitas Gavazzeni University Hospital, Bergamo, Italy
| | - Pekka Raatikainen
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Delphine De Smedt
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Angela Wood
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Dariusz Dudek
- Instytut Kardiologii, Uniwersytet Jagielloński, Collegium Medicum, Kraków, Poland
| | - Eric Van Belle
- Cardiologie, Institut cœur-poumon, CHU de Lille, Lille, France
| | - Franz Weidinger
- Department of Cardiology and Intensive Care Medicine, Landstrasse Clinic, Vienna, Austria
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2
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Banashefski B, Ji R, Dhruva SS, Neuhaus J, Redberg RF. Cardiac coronary tomography angiography (CCTA) use across geographical regions in the USA and the UK: a cross-sectional study. BMJ SURGERY, INTERVENTIONS, & HEALTH TECHNOLOGIES 2023; 5:e000201. [PMID: 38020493 PMCID: PMC10660629 DOI: 10.1136/bmjsit-2023-000201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Objective Increased use of CT imaging has been identified as a key component of unsustainable rising healthcare costs in the USA and globally. Understanding evidence and its relation to imaging coverage policies can help identify patterns of variation to better inform high value care initiatives. This cross-sectional study evaluates regional differences in US utilisation of cardiac coronary tomography angiography (CCTA) and compares use in the USA and England. Design We determined differences in CCTA order rates by US Medicare region and compared order rates in the US and England, compared CT scanner prevalence in the USA and UK, and reviewed the CCTA coverage policies for each region. Setting The US and the UK. Participants Medicare Coverage Database; Medicare 2018 Part B data; National Health Services 2018 data. Interventions CCTA orders, CT scanner prevalence. Main outcome measures CCTA orders per beneficiary, CT scanner prevalence, CCTA policy variation. Results We found that CCTA coverage policies are more permissive in the UK compared with the USA. However, CT scanner prevalence per beneficiary is four times greater in the USA than the UK. There was significant variation in number of CCTA ordered per 100 000 beneficiaries between regions in England and the USA, ranging from 74 to 313 in the US and 57-317 in England. Conclusions There is significant geographical variation in use of CCTA in both the USA and England, although overall use does not differ significantly between both countries. Similarities in order rates, despite a much higher CT scanner density in the USA, may be related to more permissive guidelines around use of CCTA in the UK. Variation in both countries may also reflect the lack of high-quality clinical outcomes data for use of CCTA, underscoring opportunities for more evidence and evidence-based policy to promote appropriate use of CCTA imaging.
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Affiliation(s)
| | - Robin Ji
- Department of Medicine, University of California School of Medicine, San Francisco, California, USA
| | - Sanket S. Dhruva
- Department of Medicine, University of California School of Medicine, San Francisco, California, USA
- San Francisco Veterans Affairs Health Care System, San Francisco, California, USA
| | - John Neuhaus
- Department of Epidemiology & Biostatistics, University of California School of Medicine, San Francisco, California, USA
| | - Rita F Redberg
- Department of Medicine, University of California School of Medicine, San Francisco, California, USA
- University of California, San Francisco, California, USA
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3
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Johnson CL, Woodward W, McCourt A, Dockerill C, Krasner S, Monaghan M, Senior R, Augustine DX, Paton M, O'Driscoll J, Oxborough D, Pearce K, Robinson S, Willis J, Sharma R, Tsiachristas A, Leeson P. Real world hospital costs following stress echocardiography in the UK: a costing study from the EVAREST/BSE-NSTEP multi-entre study. Echo Res Pract 2023; 10:8. [PMID: 37254216 DOI: 10.1186/s44156-023-00020-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 05/11/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Stress echocardiography is widely used to detect coronary artery disease, but little evidence on downstream hospital costs in real-world practice is available. We examined how stress echocardiography accuracy and downstream hospital costs vary across NHS hospitals and identified key factors that affect costs to help inform future clinical planning and guidelines. METHODS Data on 7636 patients recruited from 31 NHS hospitals within the UK between 2014 and 2020 as part of EVAREST/BSE-NSTEP clinical study, were used. Data included all diagnostic tests, procedures, and hospital admissions for 12 months after a stress echocardiogram and were costed using the NHS national unit costs. A decision tree was built to illustrate the clinical pathway and estimate average downstream hospital costs. Multi-level regression analysis was performed to identify variation in accuracy and costs at both patient, procedural, and hospital level. Linear regression and extrapolation were used to estimate annual hospital cost-savings associated with increasing predictive accuracy at hospital and national level. RESULTS Stress echocardiography accuracy varied with patient, hospital and operator characteristics. Hypertension, presence of wall motion abnormalities and higher number of hospital cardiology outpatient attendances annually reduced accuracy, adjusted odds ratio of 0.78 (95% CI 0.65 to 0.93), 0.27 (95% CI 0.15 to 0.48), 0.99 (95% CI 0.98 to 0.99) respectively, whereas a prior myocardial infarction, angiotensin receptor blocker medication, and greater operator experience increased accuracy, adjusted odds ratio of 1.77 (95% CI 1.34 to 2.33), 1.64 (95% CI 1.22 to 2.22), and 1.06 (95% CI 1.02 to 1.09) respectively. Average downstream costs were £646 per patient (SD 1796) with significant variation across hospitals. The average downstream costs between the 31 hospitals varied from £384-1730 per patient. False positive and false negative tests were associated with average downstream costs of £1446 (SD £601) and £4192 (SD 3332) respectively, driven by increased non-elective hospital admissions, adjusted odds ratio 2.48 (95% CI 1.08 to 5.66), 21.06 (95% CI 10.41 to 42.59) respectively. We estimated that an increase in accuracy by 1 percentage point could save the NHS in the UK £3.2 million annually. CONCLUSION This study provides real-world evidence of downstream costs associated with stress echocardiography practice in the UK and estimates how improvements in accuracy could impact healthcare expenditure in the NHS. A real-world downstream costing approach could be adopted more widely in evaluation of imaging tests and interventions to reflect actual value for money and support realistic planning.
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Affiliation(s)
- Casey L Johnson
- Cardiovascular Clinical Research Facility, RDM Division of Cardiovascular Medicine, University of Oxford, Oxford, OX3 9DU, UK
| | - William Woodward
- Cardiovascular Clinical Research Facility, RDM Division of Cardiovascular Medicine, University of Oxford, Oxford, OX3 9DU, UK
| | - Annabelle McCourt
- Cardiovascular Clinical Research Facility, RDM Division of Cardiovascular Medicine, University of Oxford, Oxford, OX3 9DU, UK
| | - Cameron Dockerill
- Cardiovascular Clinical Research Facility, RDM Division of Cardiovascular Medicine, University of Oxford, Oxford, OX3 9DU, UK
| | - Samuel Krasner
- Cardiovascular Clinical Research Facility, RDM Division of Cardiovascular Medicine, University of Oxford, Oxford, OX3 9DU, UK
| | - Mark Monaghan
- Kings College Hospital NHS Foundation Hospital, London, UK
| | - Roxy Senior
- Northwick Park Hospital-Royal Brompton Hospital, London, UK
| | - Daniel X Augustine
- Royal United Hospitals Bath NHS Foundation Hospital, Bath, UK
- Department for Health, University of Bath, Bath, UK
| | | | | | - David Oxborough
- Research Institute for Sports and Exercise Science, Liverpool John Moores University/Liverpool Centre for Cardiovascular Science, Liverpool, UK
| | - Keith Pearce
- Manchester University NHS Foundation Hospital, Manchester, UK
| | - Shaun Robinson
- North West Anglia NHS Foundation Hospital, Peterborough, UK
| | - James Willis
- Royal United Hospitals Bath NHS Foundation Hospital, Bath, UK
| | - Rajan Sharma
- St. George's University Hospitals NHS Foundation Hospital, London, UK
| | - Apostolos Tsiachristas
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Paul Leeson
- Cardiovascular Clinical Research Facility, RDM Division of Cardiovascular Medicine, University of Oxford, Oxford, OX3 9DU, UK.
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4
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Corballis N, Tsampasian V, Merinopoulis I, Gunawardena T, Bhalraam U, Eccleshall S, Dweck MR, Vassiliou V. CT angiography compared to invasive angiography for stable coronary disease as predictors of major adverse cardiovascular events- A systematic review and meta-analysis. Heart Lung 2023; 57:207-213. [PMID: 36257218 DOI: 10.1016/j.hrtlng.2022.09.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 09/02/2022] [Accepted: 09/25/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND Computational tomography coronary angiography (CTCA) is increasingly the diagnostic test of choice for investigating patients with stable anginal symptoms. OBJECTIVES We sought to conduct a systematic review and meta-analysis comparing CTCA with invasive coronary angiography (ICA) with regards to major adverse cardiovascular events (MACE), procedural complications and rates of revascularisation. METHODS We conducted a systematic review and meta-analysis in line with the PRISMA statement. A literature search was conducted using PubMed, MEDLINE Ovid and Embase, with three studies included in meta-analysis. Statistical analysis was undertaken using Review Manager 5.3 for MacOS software and outcomes expressed as odds ratio, with 95% confidence intervals and sensitivity analysis was conducted. RESULTS A total of 5662 patients were included in this study level meta-analysis. There was no difference in MACE between CT and angiography [2.97% v 3.45%, fixed-effect model, OR: 0.84 (0.62-1.14), p = 0.26, I2 0%] and no difference found in rates of myocardial infarction, death or stroke. CTCA was associated with a reduced rate of revascularisation [12.6% v 18.3%, fixed-effects model, OR: 0.64 (0.55-0.75), p<0.00001, I2 =0%]. However, CTCA was not associated with a significantly lower complication rate [0.5% v 1.72%, random effects model, OR: 0.52 (0.06-4.38), p = 0.55, I2 52%]. CONCLUSION CTCA is a safe strategy for investigating patients with stable angina with no associated increase in MACE but a reduction in revascularisation rates.
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Affiliation(s)
- Natasha Corballis
- Department of cardiology, Norfolk and Norwich University Hospital; Norwich Medical School, University of East Anglia
| | - Vasiliki Tsampasian
- Department of cardiology, Norfolk and Norwich University Hospital; Norwich Medical School, University of East Anglia
| | - Ioannis Merinopoulis
- Department of cardiology, Norfolk and Norwich University Hospital; Norwich Medical School, University of East Anglia
| | - Tharusha Gunawardena
- Department of cardiology, Norfolk and Norwich University Hospital; Norwich Medical School, University of East Anglia
| | - U Bhalraam
- Department of cardiology, Norfolk and Norwich University Hospital; Norwich Medical School, University of East Anglia
| | - Simon Eccleshall
- Department of cardiology, Norfolk and Norwich University Hospital
| | - Marc R Dweck
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Vassilios Vassiliou
- Department of cardiology, Norfolk and Norwich University Hospital; Norwich Medical School, University of East Anglia.
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5
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Weir-McCall JR, Williams MC, Shah ASV, Roditi G, Rudd JHF, Newby DE, Nicol ED. National Trends in Coronary Artery Disease Imaging: Associations With Health Care Outcomes and Costs. JACC Cardiovasc Imaging 2022; 16:659-671. [PMID: 36752441 DOI: 10.1016/j.jcmg.2022.10.022] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 10/14/2022] [Accepted: 10/24/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND In 2016, the National Institute for Health and Care Excellence Clinical Guideline Number 95 ("Chest pain of recent onset") (CG95) recommended coronary computed tomography angiography (CCTA) as the first-line test for possible angina. OBJECTIVES The purpose of this study was to determine the impact of temporal trends in imaging use on outcomes for coronary artery disease (CAD) following the CG95 recommendations. METHODS Investigations from 2012 to 2018 were extracted from a national database and linked-hospital admission and mortality registries. Growth rates were adjusted for population size, with image modality use, cardiovascular hospital admissions, and mortality compared using Kendall's rank correlation. The impact of CG95 was assessed using an interrupted time-series analysis. RESULTS A total of 1,909,314 investigations for CAD were performed, with an annualized per capita growth of 4.8%. Costs were £0.35 million/100,000 population/year with an increase of 2.8%/year mirroring inflation (2.5%/year). CG95 was associated with a rise in CCTA (exp[β]: 1.10; 95% CI: 1.03-1.18), no change in myocardial perfusion imaging, and a potential modest fall (exp[β]: 0.997; 95% CI: 0.993-1.00]) in invasive coronary angiography. There was an apparent trend between computed tomography angiography growth and invasive catheter angiography reduction across regions (Kendall Tau: -0.19; P = 0.08). CCTA growth was associated with a reduction in cardiovascular mortality (Kendall Tau: -0.21; P = 0.045), and ischemic heart disease deaths (Kendall Tau: -0.22; P = 0.042), with an apparent trend with reduced all-cause mortality (Kendall Tau: -0.19; P = 0.07). CONCLUSIONS Imaging investigations for CAD are increasing. Greater regional increases in CCTA were associated with fewer hospitalizations for myocardial infarction and a more rapid decline in CAD mortality.
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Affiliation(s)
- Jonathan R Weir-McCall
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom; Royal Papworth Hospital, Cambridge, United Kingdom
| | - Michelle C Williams
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - Anoop S V Shah
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Giles Roditi
- Glasgow Royal Infirmary, NHS Greater Glasgow, Glasgow, United Kingdom
| | - James H F Rudd
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - David E Newby
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - Edward D Nicol
- Royal Brompton and Harefield NHS Foundation Trust, Departments of Cardiology and Radiology, London, United Kingdom; School of Biomedical Engineering and Imaging Sciences, Kings College London, United Kingdom.
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6
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Woodward W, Dockerill C, McCourt A, Upton R, O'Driscoll J, Balkhausen K, Chandrasekaran B, Firoozan S, Kardos A, Wong K, Woodward G, Sarwar R, Sabharwal N, Benedetto E, Spagou N, Sharma R, Augustine D, Tsiachristas A, Senior R, Leeson P, Boardman H, d'Arcy J, Abraheem A, Banypersad S, Boos C, Bulugahapitiya S, Butts J, Coles D, Easaw J, Hamdan H, Jamil-Copley S, Kanaganayagam G, Mwambingu T, Pantazis A, Papachristidis A, Rajani R, Rasheed MA, Razvi NA, Rekhraj S, Ripley DP, Rose K, Scheuermann-Freestone M, Schofield R, Sultan A. Real-world performance and accuracy of stress echocardiography: the EVAREST observational multi-centre study. Eur Heart J Cardiovasc Imaging 2021; 23:689-698. [PMID: 34148078 PMCID: PMC9016358 DOI: 10.1093/ehjci/jeab092] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/04/2021] [Indexed: 12/22/2022] Open
Abstract
Aims Stress echocardiography is widely used to identify obstructive coronary artery disease (CAD). High accuracy is reported in expert hands but is dependent on operator training and image quality. The EVAREST study provides UK-wide data to evaluate real-world performance and accuracy of stress echocardiography. Methods and results Participants undergoing stress echocardiography for CAD were recruited from 31 hospitals. Participants were followed up through health records which underwent expert adjudication. Cardiac outcome was defined as anatomically or functionally significant stenosis on angiography, revascularization, medical management of ischaemia, acute coronary syndrome, or cardiac-related death within 6 months. A total of 5131 patients (55% male) participated with a median age of 65 years (interquartile range 57–74). 72.9% of studies used dobutamine and 68.5% were contrast studies. Inducible ischaemia was present in 19.3% of scans. Sensitivity and specificity for prediction of a cardiac outcome were 95.4% and 96.0%, respectively, with an accuracy of 95.9%. Sub-group analysis revealed high levels of predictive accuracy across a wide range of patient and protocol sub-groups, with the presence of a resting regional wall motion abnormalitiy significantly reducing the performance of both dobutamine (P < 0.01) and exercise (P < 0.05) stress echocardiography. Overall accuracy remained consistently high across all participating hospitals. Conclusion Stress echocardiography has high accuracy across UK-based hospitals and thus indicates stress echocardiography is being delivered effectively in real-world practice, reinforcing its role as a first-line investigation in the assessment of patients with stable chest pain.
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Affiliation(s)
- William Woodward
- Cardiovascular Clinical Research Facility, RDM Division of Cardiovascular Medicine, University of Oxford, Oxford OX3 9DU, UK
| | - Cameron Dockerill
- Cardiovascular Clinical Research Facility, RDM Division of Cardiovascular Medicine, University of Oxford, Oxford OX3 9DU, UK
| | - Annabelle McCourt
- Cardiovascular Clinical Research Facility, RDM Division of Cardiovascular Medicine, University of Oxford, Oxford OX3 9DU, UK
| | - Ross Upton
- Cardiovascular Clinical Research Facility, RDM Division of Cardiovascular Medicine, University of Oxford, Oxford OX3 9DU, UK.,Ultromics Ltd, Wood Centre for Innovation, OxfordOX3 8SB, UK
| | - Jamie O'Driscoll
- Department of Cardiology, St George's University Hospitals NHS Foundation Trust, London SW17 0QT, UK.,School of Human and Life Sciences, Canterbury Christ Church University, Canterbury CT1 1QU, UK
| | - Katrin Balkhausen
- Department of Cardiology, Royal Berkshire Hospitals NHS Foundation Trust, Reading RG1 5AN, UK
| | | | - Soroosh Firoozan
- Department of Cardiology, Buckinghamshire Healthcare NHS Trust, High Wycombe HP11 2TT, UK
| | - Attila Kardos
- Department of Cardiology, Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes MK6 5LD, UK
| | - Kenneth Wong
- Lancashire Cardiac Centre, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool FY3 8NP, UK
| | - Gary Woodward
- Ultromics Ltd, Wood Centre for Innovation, OxfordOX3 8SB, UK
| | - Rizwan Sarwar
- Ultromics Ltd, Wood Centre for Innovation, OxfordOX3 8SB, UK.,Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 9DU, UK
| | - Nikant Sabharwal
- Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 9DU, UK
| | - Elena Benedetto
- Cardiovascular Clinical Research Facility, RDM Division of Cardiovascular Medicine, University of Oxford, Oxford OX3 9DU, UK
| | - Nancy Spagou
- Ultromics Ltd, Wood Centre for Innovation, OxfordOX3 8SB, UK
| | - Rajan Sharma
- Department of Cardiology, St George's University Hospitals NHS Foundation Trust, London SW17 0QT, UK
| | - Daniel Augustine
- Department of Cardiology, Royal United Hospitals NHS Foundation Trust, Bath, BA1 3NG, UK
| | - Apostolos Tsiachristas
- Health Economic Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | - Roxy Senior
- National Heart and Lung Institute, Imperial College London, London SW3 6LY, UK.,Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, London SW3 6NJ, UK.,Department of Cardiology, London North West University Healthcare NHS Trust, London HA1 3UJ, UK
| | - Paul Leeson
- Cardiovascular Clinical Research Facility, RDM Division of Cardiovascular Medicine, University of Oxford, Oxford OX3 9DU, UK
| | - Henry Boardman
- Department of Cardiology, Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes MK6 5LD, UK.,Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 9DU, UK
| | - Joanna d'Arcy
- Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 9DU, UK
| | - Abraheem Abraheem
- Department of Cardiology, Tameside and Glossop Integrated Care NHS Foundation Trust, Ashton-under-Lyne, UK
| | - Sanjay Banypersad
- Department of Cardiology, East Lancashire Hospitals NHS Trust, Burnley, UK
| | - Christopher Boos
- Department of Cardiology, Poole Hospital NHS Foundation Trust, Poole, UK
| | | | - Jeremy Butts
- Department of Cardiology, Calderdale and Huddersfield NHS Foundation Trust, Calderdale, UK
| | - Duncan Coles
- Department of Cardiology, Mid Essex NHS Hospital Services NHS Trust, Broomfield, UK
| | - Jacob Easaw
- Department of Cardiology, Royal United Hospitals NHS Foundation Trust, Bath, BA1 3NG, UK
| | - Haytham Hamdan
- Department of Cardiology, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - Shahnaz Jamil-Copley
- Department of Cardiology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Gajen Kanaganayagam
- Department of Cardiology, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Tom Mwambingu
- Department of Cardiology, The Mid Yorkshire Hospitals NHS Trust, Pinderfields, UK
| | - Antonis Pantazis
- Department of Cardiology, North Middlesex University Hospital NHS Trust, London, UK
| | | | - Ronak Rajani
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Naveed A Razvi
- Department of Cardiology, East Suffolk and North Essex NHS Foundation Trust, Ipswich, UK
| | - Sushma Rekhraj
- Department of Cardiology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - David P Ripley
- Department of Cardiology, Northumbria Healthcare NHS Foundation Trust, North Tyneside, UK
| | - Kathleen Rose
- Department of Cardiology, Northampton General Hospital NHS Trust, Northampton, UK
| | | | - Rebecca Schofield
- Department of Cardiology, North West Anglia NHS Foundation Trust, Peterborough, UK
| | - Ayyaz Sultan
- Department of Cardiology, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
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7
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Morgan-Hughes G, Williams MC, Loudon M, Roobottom CA, Iacovides S, Wotton F, Veitch A, Bull R. Sex-based inequalities in contemporary UK hospital management of stable chest pain. Open Heart 2021; 8:e001672. [PMID: 34083391 PMCID: PMC8174516 DOI: 10.1136/openhrt-2021-001672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 05/19/2021] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE We surveyed UK practice of National Institute for Health and Care Excellence (NICE) "Recent onset chest pain" guidance (CG95, 2016), stratified by sex. We looked for sex-related differences in referral to computed tomographic coronary angiography (CTCA) and subsequent functional imaging (FI), invasive coronary angiography (ICA) and revascularisation. METHODS This was a prospective analysis of CTCA practice in 8 UK centres between 2018 and 2020. Coronary artery disease (CAD) was recorded with the CAD-reporting and data system. Local electronic records/archiving/communication systems were used to collect data regarding subsequent FI, ICA and revascularisation. RESULTS 2301 women, 2326 men underwent CTCA; women were older (58±11 vs 55±12 years, p<0.001) but more likely to have normal coronary arteries (46% (1047) vs 29% (685); p<0.001) and less likely to have severe stenosis (7% (169) vs 13% (307); p<0.001). FI was used less for 4% (93) women, 5% (108) men; ICA was also used less for women (8% (182) vs 14% (321)), as was revascularisation (4% (83) vs 8% (177), p<0.001 for all), including those with ≥moderate CTCA stenosis undergoing ICA (53% (79) vs 61% (166); p<0.001). CONCLUSIONS Women referred for a NICE CG95 (2016) CTCA are more likely to have normal coronary arteries and men more likely to have CAD. More men than women will then undergo ICA and revascularisation even after adjustments for CTCA disease severity. Raised awareness of these inequalities may improve contemporary chest pain care.
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Affiliation(s)
| | | | - Margaret Loudon
- Cardiology, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Carl A Roobottom
- Radiology, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | | | | | - Alice Veitch
- Salisbury Hospital NHS Foundation Trust, Salisbury, Wiltshire, UK
| | - Russel Bull
- Radiology, Royal Bournemouth Hospital, Bournemouth, UK
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8
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Schofield R, Menezes L, Underwood SR. Nuclear cardiology: state of the art. Heart 2021; 107:954-961. [PMID: 33483353 DOI: 10.1136/heartjnl-2019-315628] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 12/04/2020] [Accepted: 12/11/2020] [Indexed: 12/11/2022] Open
Abstract
Radionuclide imaging remains an essential component of modern cardiology. There is overlap with the information from other imaging techniques, but no technique is static and new developments have expanded its role. This review focuses on ischaemic heart disease, heart failure, infection and inflammation. Radiopharmaceutical development includes the wider availability of positron emission tomography (PET) tracers such as rubidium-82, which allows myocardial perfusion to be quantified in absolute terms. Compared with alternative techniques, myocardial perfusion scintigraphy PET and single photon emission computed tomography (SPECT) have the advantages of being widely applicable using exercise or pharmacological stress, full coverage of the myocardium and a measure of ischaemic burden, which helps to triage patients between medical therapy and revascularisation. Disadvantages include the availability of expertise in some cardiac centres and the lack of simple SPECT quantification, meaning that global abnormalities can be underestimated. In patients with heart failure, despite the findings of the STICH (Surgical Treatment for Ischemic Heart Failure) trial, there are still data to support the assessment of myocardial hibernation in predicting when abolition of ischaemia might lead to improvement in ventricular function. Imaging of sympathetic innervation is well validated, but simpler markers of prognosis mean that it has not been widely adopted. There are insufficient data to support its use in predicting the need for implanted devices, but non-randomised studies are promising. Other areas where radionuclide imaging is uniquely valuable are detection and monitoring of endocarditis, device infection, myocardial inflammation in sarcoidosis, myocarditis and so on, and reliable detection of deposition in suspected transthyretin-related amyloidosis.
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Affiliation(s)
- Rebecca Schofield
- Department of Cardiology, North West Anglia NHS Foundation Trust, Peterborough, Cambridgeshire, UK
| | - Leon Menezes
- Institute of Nuclear Medicine, University College London Hospitals NHS Foundation Trust, London, UK
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9
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Keenan NG, Captur G, McCann GP, Berry C, Myerson SG, Fairbairn T, Hudsmith L, O'Regan DP, Westwood M, Greenwood JP. Regional variation in cardiovascular magnetic resonance service delivery across the UK. Heart 2021; 107:1974-1979. [PMID: 33766986 PMCID: PMC8639953 DOI: 10.1136/heartjnl-2020-318667] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/16/2021] [Accepted: 02/20/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To examine service provision in cardiovascular magnetic resonance (CMR) in the UK. Equitable access to diagnostic imaging is important in healthcare. CMR is widely available in the UK, but there may be regional variations. METHODS An electronic survey was sent by the British Society of CMR to the service leads of all CMR units in the UK in 2019 requesting data from 2017 and 2018. Responses were analysed by region and interpreted alongside population statistics. RESULTS The survey response rate was 100% (82 units). 100 386 clinical scans were performed in 2017 and 114 967 in 2018 (15% 1-year increase; 5-fold 10-year increase compared with 2008 data). In 2018, there were 1731 CMR scans/million population overall, with significant regional variation, for example, 4256 scans/million in London vs 396 scans/million in Wales. Median number of clinical scans per unit was 780, IQR 373-1951, range 98-10 000, with wide variation in mean waiting times (median 41 days, IQR 30-49, range 5-180); median 25 days in London vs 180 days in Northern Ireland). Twenty-five units (30%) reported mean elective waiting times in excess of 6 weeks, and 8 (10%) ≥3 months. There were 351 consultants reporting CMR, of whom 230 (66%) were cardiologists and 121 (34%) radiologists; 81% of units offered a CMR service for patients with pacemakers and defibrillators. CONCLUSIONS This survey provides a unique, contemporary insight into national CMR delivery with 100% centre engagement. The 10-year growth in CMR usage at fivefold has been remarkable but heterogeneous across the UK, with some regions still reporting low usage or long waiting times which may be of clinical concern.
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Affiliation(s)
- Niall G Keenan
- Cardiology, West Hertfordshire Hospitals NHS Trust, Watford, Hertfordshire, UK .,MRC London Institute of Medical Sciences, Imperial College London, London, UK
| | - Gabriella Captur
- University College London Institute of Cardiovascular Science, London, UK.,Centre for Inherited Heart Muscle Conditions, Royal Free Hospital, London, UK
| | - Gerry P McCann
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Colin Berry
- BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.,Cardiology, Golden Jubilee National Hospital, Clydebank, UK
| | - Saul G Myerson
- University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Timothy Fairbairn
- Cardiology, Liverpool Heart and Chest Hospital NHS Trust, Liverpool, Merseyside, UK
| | - Lucy Hudsmith
- Adult Congenital Heart Disease Unit, University Hospitals Birmingham, Birmingham, West Midlands, UK
| | - Declan P O'Regan
- MRC London Institute of Medical Sciences, Imperial College London, London, UK
| | | | - John P Greenwood
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.,Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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10
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Dockerill C, Woodward W, McCourt A, Monteiro C, Benedetto E, Paton M, Oxborough D, Robinson S, Pearce K, Monaghan MJ, Augustine DX, Leeson P. Impact of COVID-19 on UK stress echocardiography practice: insights from the EVAREST sites. Echo Res Pract 2021; 8:1-8. [PMID: 33739936 PMCID: PMC8111306 DOI: 10.1530/erp-20-0043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/11/2021] [Indexed: 11/08/2022] Open
Abstract
Introduction Healthcare delivery is being transformed by COVID-19 to reduce transmission risk but continued delivery of routine clinical tests is essential. Stress echocardiography is one of the most widely used cardiac tests in the NHS. We assessed the impact of the first (W1) and second (W2) waves of the pandemic on the ability to deliver stress echocardiography. Methods Clinical echocardiography teams in 31 NHS hospitals participating in the EVAREST study were asked to complete a survey on the structure and delivery of stress echocardiography as well as its impact on patients and staff in July and November 2020. Results were compared to stress echocardiography activity in the same centre during January 2020. Results 24 completed the survey in July, and 19 NHS hospitals completed the survey in November. A 55% reduction in the number of studies performed was reported in W1, recovering to exceed pre-COVID rates in W2. The major change was in the mode of stress delivery. 70% of sites stopped their exercise stress service in W1, compared to 19% in W2. In those still using exercise during W1, 50% were wearing FFP3/N95 masks, falling to 38% in W2. There was also significant variability in patient screening practices with 7 different pre-screening questionnaires used in W1 and 6 in W2. Conclusion Stress echocardiography delivery restarted effectively after COVID-19 with adaptations to reduce transmission that means activity has been able to continue, and exceed, pre-COVID-19 levels during the second wave. Further standardization of protocols for patient screening and PPE may help further improve consistency of practice within the United Kingdom.
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Affiliation(s)
- Cameron Dockerill
- Cardiovascular Clinical Research Facility, RDM Division of Cardiovascular Medicine, University of Oxford, Oxford, UK
| | - William Woodward
- Cardiovascular Clinical Research Facility, RDM Division of Cardiovascular Medicine, University of Oxford, Oxford, UK
| | - Annabelle McCourt
- Cardiovascular Clinical Research Facility, RDM Division of Cardiovascular Medicine, University of Oxford, Oxford, UK
| | - Cristiana Monteiro
- Cardiovascular Clinical Research Facility, RDM Division of Cardiovascular Medicine, University of Oxford, Oxford, UK
| | - Elena Benedetto
- Cardiovascular Clinical Research Facility, RDM Division of Cardiovascular Medicine, University of Oxford, Oxford, UK
| | - Maria Paton
- School of Medicine, University of Leeds, Leeds, UK
| | - David Oxborough
- Cardiovascular Physiology, School of Sport and Exercise Sciences, Liverpool, UK
| | - Shaun Robinson
- North West Anglia NHS Foundation Trust, Bretton Gate, Bretton, Peterborough, Cambridgeshire, UK
| | - Keith Pearce
- Manchester University NHS Foundation Trust, Wythenshawe Hospital, Wythenshawe, Manchester, UK
| | - Mark J Monaghan
- King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK
| | - Daniel X Augustine
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK.,Department for Health, University of Bath, Bath, Somerset, UK
| | - Paul Leeson
- Cardiovascular Clinical Research Facility, RDM Division of Cardiovascular Medicine, University of Oxford, Oxford, UK
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11
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Morgan-Hughes G, Williams MC, Loudon M, Roobottom CA, Veitch A, Van Lingen R, Holloway B, Bellenger N, Schmitt M, Bull R. Downstream testing after CT coronary angiography: time for a rethink? Open Heart 2021; 8:openhrt-2021-001597. [PMID: 33622963 PMCID: PMC7907873 DOI: 10.1136/openhrt-2021-001597] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 02/07/2021] [Accepted: 02/08/2021] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE We surveyed UK practice and compliance with the National Institute for Health and Care Excellence (NICE) 'recent-onset chest pain' guidance (Clinical Guideline 95, 2016) as a service quality initiative. We aimed to evaluate the diagnostic utility and efficacy of CT coronary angiography (CTCA), NICE-guided investigation compliance, invasive coronary angiography (ICA) use and revascularisation. METHODS A prospective analysis was conducted in nine UK centres between January 2018 and March 2020. The reporter decided whether the CTCA was diagnostic. Coronary artery disease was recorded with the Coronary Artery Disease-Reporting and Data System (CAD-RADS). Local electronic records and picture archiving/communication systems were used to collect data regarding functional testing, ICA and revascularisation. Duplication of coronary angiography without revascularisation was taken as a surrogate for ICA overuse. RESULTS 5293 patients (mean age, 57±12 years; body mass index, 29±6 kg/m²; 50% men) underwent CTCA, with a 96% diagnostic scan rate. 618 (12%) underwent ICA, of which 48% (298/618) did not receive revascularisation. 3886 (73%) had CAD-RADS 0-2, with 1% (35/3886) undergoing ICA, of which 94% (33/35) received ICA as a second-line test. 547 (10%) had CAD-RADS 3, with 23% (125/547) undergoing ICA, of which 88% (110/125) chose ICA as a second-line test, with 26% (33/125) leading to revascularisation. For 552 (10%) CAD-RADS 4 and 91 (2%) CAD-RADS 5 patients, ICA revascularisation rates were 64% (221/345) and 74% (46/62), respectively. CONCLUSIONS While CTCA for recent-onset chest pain assessment has been shown to be a robust test, which negates the need for further investigation in three-quarters of patients, subsequent ICA overuse remains with almost half of these procedures not leading to revascularisation.
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Affiliation(s)
| | - Michelle Claire Williams
- Centre for Cardiovascular Sciences, University of Edinburgh, Edinburgh, Lothian, UK.,Radiology, University of Edinburgh, Edinburgh, UK
| | - Margaret Loudon
- Cardiology, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Carl A Roobottom
- Radiology, University Hospitals Plymouth NHS Trust, Plymouth, Plymouth, UK
| | - Alice Veitch
- Radiology, Salisbury Hospital NHS Foundation Trust, Salisbury, Wiltshire, UK
| | - Robin Van Lingen
- Radiology, Royal Cornwall Hospitals NHS Trust, Truro, Cornwall, UK
| | - Ben Holloway
- Radiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Matthias Schmitt
- Cardiology, Manchester University NHS Foundation Trust, Manchester, Greater Manchester, UK
| | - Russel Bull
- Radiology, Royal Bournemouth Hospital, Bournemouth, Bournemouth, UK
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12
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Petersen SE, Friebel R, Ferrari V, Han Y, Aung N, Kenawy A, Albert TSE, Naci H. Recent Trends and Potential Drivers of Non-invasive Cardiovascular Imaging Use in the United States of America and England. Front Cardiovasc Med 2021; 7:617771. [PMID: 33575273 PMCID: PMC7870990 DOI: 10.3389/fcvm.2020.617771] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 12/18/2020] [Indexed: 12/30/2022] Open
Abstract
Background: Non-invasive Cardiovascular imaging (NICI), including cardiovascular magnetic resonance (CMR) imaging provides important information to guide the management of patients with cardiovascular conditions. Current rates of NICI use and potential policy determinants in the United States of America (US) and England remain unexplored. Methods: We compared NICI activity in the US (Medicare fee-for-service, 2011-2015) and England (National Health Service, 2012-2016). We reviewed recommendations related to CMR from Clinical Practice Guidelines, Appropriate Use Criteria (AUC), and Choosing Wisely. We then categorized recommendations according to whether CMR was the only recommended NICI technique (substitutable indications). Reimbursement policies in both settings were systematically collated and reviewed using publicly available information. Results: The 2015 rate of NICI activity in the US was 3.1 times higher than in England (31,055 vs. 9,916 per 100,000 beneficiaries). The proportion of CMR of all NICI was small in both jurisdictions, but nuclear cardiac imaging was more frequent in the US in absolute and relative terms. American and European CPGs were similar, both in terms of number of recommendations and proportions of indications where CMR was not the only recommended NICI technique (substitutable indications). Reimbursement schemes for NICI activity differed for physicians and hospitals between the two settings. Conclusions: Fee-for-service physician compensation in the US for NICI may contribute to higher NICI activity compared to England where physicians are salaried. Reimbursement arrangements for the performance of the test may contribute to the higher proportion of nuclear cardiac imaging out of the total NICI activity. Differences in CPG recommendations appear not to explain the variation in NICI activity between the US and England.
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Affiliation(s)
- Steffen E. Petersen
- Barts Heart Centre St Bartholomew's Hospital, Barts Health National Health Service (NHS) Trust, London, United Kingdom
- William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Rocco Friebel
- Department of Health Policy, The London School of Economics and Political Science, London, United Kingdom
- Center for Global Development, London, United Kingdom
| | - Victor Ferrari
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, United States
| | - Yuchi Han
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, United States
| | - Nay Aung
- Barts Heart Centre St Bartholomew's Hospital, Barts Health National Health Service (NHS) Trust, London, United Kingdom
- William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Asmaa Kenawy
- Barts Heart Centre St Bartholomew's Hospital, Barts Health National Health Service (NHS) Trust, London, United Kingdom
- William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | | | - Huseyin Naci
- Department of Health Policy, The London School of Economics and Political Science, London, United Kingdom
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13
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Asher A, Wragg A, Davies C. Review: FFRCT Changing the Face of Cardiac CT. CURRENT CARDIOVASCULAR IMAGING REPORTS 2020. [DOI: 10.1007/s12410-020-09548-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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14
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Krysztofiak T, Ahmad F, Adams J, Stobo DB, Good R, Byrne J. The value of non-invasive computed tomography coronary angiography in imaging patients with coronary artery bypass grafts. Scott Med J 2020; 65:76-80. [PMID: 32580687 DOI: 10.1177/0036933020936274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Invasive coronary angiography (ICA) is associated with higher complication rates in patients following coronary artery bypass surgery (CABG). CT coronary angiography (CTCA) has emerged as an attractive alternative. We assessed the impact of CTCA on subsequent ICA. METHODS We identified 213 CABG patients undergoing CTCA between 2015 and 2018. In 151 the indication was suspected recurrence of angina. We then identified patients undergoing ICA within 1 year of CTCA. RESULTS CTCA obviated the need for ICA in 115 cases (76%). CTCA was better at identifying targets for percutaneous coronary intervention (PCI) to saphenous vein grafts (SVG's) than to native vessels (89% vs 47%). 7 out of 10 lesions of "probable" significance by CTCA proved flow-limiting, and 4 out of 13 "indeterminate" lesions. CTCA concordance was 97% for left internal mammary (LIMA) grafts. CONCLUSION CTCA directed management in a majority of patients without ICA. It identified a cohort of patients likely to be candidates for SVG PCI, but was less effective in identifying PCI targets in the native vessels. CTCA renders invasive LIMA cannulation redundant unless a target lesion is suspected.
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Affiliation(s)
- T Krysztofiak
- Cardiology Clinical Fellow, Department of Cardiology, Golden Jubilee National Hospital, UK
| | - F Ahmad
- Cardiology Specialist Registrar, Department of Cardiology, Golden Jubilee National Hospital, UK
| | - J Adams
- Consultant Cardiologist, Department of Cardiology, Golden Jubilee National Hospital, UK
| | - D B Stobo
- Consultant Radiologist, Department of Radiology, Golden Jubilee National Hospital, UK
| | - R Good
- Consultant Cardiologist, Department of Cardiology, Golden Jubilee National Hospital, UK
| | - J Byrne
- Consultant Cardiologist, Department of Cardiology, Golden Jubilee National Hospital, UK
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