Coronary Reactivity Assessment Is Associated With Lower Health Care-Associated Costs in Patients Presenting With Angina and Nonobstructive Coronary Artery Disease.

Autor:	Ahmad A; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (A.A., M.T.C., Y.K., R.G., C.S.R., A.P., J.D.S., L.O.L., A.L.).; Department of Internal Medicine, Saint Louis University School of Medicine, MO (A.A.)., Corban MT; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (A.A., M.T.C., Y.K., R.G., C.S.R., A.P., J.D.S., L.O.L., A.L.).; Division of Cardiology, Department of Medicine, University of Arizona College of Medicine, Tucson (M.T.C.)., Moriarty JP; Economic Evaluation Unit, Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN (J.P.M., J.K.R., B.B.)., Kanaji Y; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (A.A., M.T.C., Y.K., R.G., C.S.R., A.P., J.D.S., L.O.L., A.L.)., Rosedahl JK; Economic Evaluation Unit, Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN (J.P.M., J.K.R., B.B.)., Gulati R; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (A.A., M.T.C., Y.K., R.G., C.S.R., A.P., J.D.S., L.O.L., A.L.)., Rihal CS; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (A.A., M.T.C., Y.K., R.G., C.S.R., A.P., J.D.S., L.O.L., A.L.)., Prasad A; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (A.A., M.T.C., Y.K., R.G., C.S.R., A.P., J.D.S., L.O.L., A.L.)., Sara JD; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (A.A., M.T.C., Y.K., R.G., C.S.R., A.P., J.D.S., L.O.L., A.L.)., Toya T; Division of Cardiology, National Defense Medical College, Tokorozawa, Saitama, Japan (T.T.)., Ter Horst I; Philips Medical Systems, Eindhoven, the Netherlands (I.t.H.)., Lerman LO; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (A.A., M.T.C., Y.K., R.G., C.S.R., A.P., J.D.S., L.O.L., A.L.).; Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN (L.O.L.)., Borah B; Economic Evaluation Unit, Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN (J.P.M., J.K.R., B.B.).; Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN (B.B.)., Lerman A; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (A.A., M.T.C., Y.K., R.G., C.S.R., A.P., J.D.S., L.O.L., A.L.).
Jazyk:	angličtina
Zdroj:	Circulation. Cardiovascular interventions [Circ Cardiovasc Interv] 2023 Jul; Vol. 16 (7), pp. e012387. Date of Electronic Publication: 2023 Jul 07.
DOI:	10.1161/CIRCINTERVENTIONS.122.012387
Abstrakt:	Background: The financial burden linked to the diagnosis and treatment of patients with chest pain on the health care system is considerable. Angina and nonobstructive coronary artery disease (ANOCA) is common, associated with adverse cardiovascular events, and may lead to repeat testing or hospitalizations. Diagnostic certainty can be achieved in patients with ANOCA using coronary reactivity testing (CRT); however, its financial effect on the patient has not been studied. Our goal was to assess the effect of CRT on health care-related cost in patients with ANOCA. Methods: Patients with ANOCA who underwent diagnostic coronary angiography (CAG) and CRT (CRT group) were matched to controls who had similar presentation but only underwent a CAG without CRT (CAG group). Standardized inflation-adjusted costs were collected and compared between the 2 groups on an annual basis for 2 years post the index date (CRT or CAG). Results: Two hundred seven CRT and 207 CAG patients were included in the study with an average age of 52.3±11.5 years and 76% females. The total cost was significantly higher in the CAG group as compared with the CRT group ($37 804 [$26 933-$48 674] versus $13 679 [$9447-$17 910]; P <0.001). When costs are itemized and divided based on the Berenson-Eggers Type of Service categorization, the largest cost difference occurred in imaging (any type, including CAG; P <0.001), procedures (eg, percutaneous coronary intervention/coronary artery bypass grafting/thrombectomy) ( P =0.001), and test (eg, blood tests, EKG; P <0.001). Conclusions: In this retrospective observational study, assessment of CRT in patients with ANOCA was associated with significantly reduced annual total costs and health care utilization. Therefore, the study may support the integration of CRT into clinical practice. Competing Interests: Disclosures Dr Lerman declares honoraria for Philips Volcano. The other authors report no conflicts.
Databáze:	MEDLINE
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