Computed tomography coronary angiography for patients with heart failure (CTA-HF): a randomized controlled trial (IMAGE-HF 1C)
| Autor: | Juhani Knuuti, George A. Wells, Kim A. Connelly, Miroslav Rajda, Helena Hänninen, Doug Coyle, Gary W. Small, Malek Kass, Eric Larose, Kathryn Coyle, Mika Laine, Rob S. Beanlands, Benjamin J.W. Chow, Heikki Ukkonen, Seppo Ylä-Herttuala, Alomgir Hossain, Marja Hedman, Lisa Mielniczuk, Linda Garrard, Eileen O'Meara, Juha Hartikainen, Helen Bishop |
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| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
Cost effectiveness Computed Tomography Angiography heart failure Coronary Artery Disease 030204 cardiovascular system & hematology Chest pain Coronary Angiography coronary CT angiography law.invention Coronary artery disease 03 medical and health sciences 0302 clinical medicine Randomized controlled trial law Internal medicine medicine Humans Radiology Nuclear Medicine and imaging 030212 general & internal medicine cost-effectiveness Aged Heart Failure Ejection fraction Ischemic cardiomyopathy business.industry General Medicine Middle Aged medicine.disease Confidence interval Heart failure randomized controlled trial Cardiology Quality of Life medicine.symptom Cardiology and Cardiovascular Medicine business |
| Zdroj: | European heart journal. Cardiovascular Imaging. 22(9) |
| ISSN: | 2047-2412 |
| Popis: | Aims This randomized controlled trial sought to determine the financial impact of an initial diagnostic strategy of coronary computed tomography angiography (CCTA) in patients with heart failure (HF) of unknown aetiology. Invasive coronary angiography (ICA) is used to investigate HF patients. CCTA may be a non-invasive cost-effective alternative to ICA. This randomized controlled trial sought to determine the financial impact of an initial diagnostic strategy of coronary computed tomography angiography (CCTA) in patients with heart failure (HF) of unknown aetiology. Methods and results This multicentre, international trial enrolled patients with HF of unknown aetiology. The primary outcome was the cost of CCTA vs. ICA strategies at 12 months. Clinical outcomes were also collected. An ‘intention-to-diagnose’ analysis was performed and a secondary ‘as-tested’ analysis was based on the modality received. Two hundred and forty-six patients were randomized (age = 57.8 ± 11.0 years, ejection fraction = 30.1 ± 10.1%). The severity of coronary artery disease was similar in both groups. In the 121 CCTA patients, 93 avoided ICA. Rates of downstream ischaemia and viability testing were similar for both arms. There were no significant differences in the composite clinical outcomes or quality of life measures. The cost of CCTA trended lower than ICA [CDN −$871 (confidence interval, CI −$4116 to $3028)]. Using an ‘as-tested’ analysis, CCTA was associated with a decrease in healthcare costs (CDN −$2932, 95% CI −$6248 to $746). Conclusion In patients with HF of unknown aetiology, costs were not statistically different between the CCTA and ICA strategies. Clinical Trials.gov NCT01283659 |
| Databáze: | OpenAIRE |
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