Bainey Kevin R, Durham Daniel, Zheng Yinggan, Westerhout Cynthia M, Kaul Padma, Welsh Robert C
Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada.
The Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada.
CJC Open. 2019 Feb 19;1(2):76-83. doi: 10.1016/j.cjco.2019.01.006. eCollection 2019 Mar.
Although appropriate noninvasive cardiac tests (NICTs) after an acute coronary syndrome (ACS) provide useful prognostic information, inappropriate use leads to inefficient expenditure of existing healthcare resources. By using the Alberta ntemporary cute Coronary Syndrome atient Invasive reatment Strategies (COAPT) Registry, we evaluated the use and costs of NICTs among patients discharged within 1 year after ACS.
All patients discharged from the hospital with a primary diagnosis of ACS in Alberta between 2004/2005 and 2015/2016 were included. Frequency of NICTs (stress tests [± imaging] and nonstress imaging tests) was determined from linked provincial databases. Costs were obtained from the Alberta Health Care Insurance Plan Medical Procedure List.
Of 55,516 patients with ACS, 30,760 had at least 1 NICT (55.4%), with 13,505 (24.3%) having > 1 NICT performed within 1 year. Temporal trends of NICT increased over time (stress tests: trend < 0.001; nonstress imaging tests: trend < 0.001). NICT most commonly occurred within the first 4 months after hospital discharge (stress tests at 2 months; nonstress imaging tests at 3-4 months). In 2015/2016, the total estimated costs of NICT were $1.35M, a 22.4% increase from 2004/2005 (1.10M) ( 0.001), whereas a decrease in incidence of ACS over the same time period was noted ( 0.008).
Rates of NICT 1 year after ACS are high and increasing over time. Estimated costs of NICT appear to be escalating out of proportion to the ACS growth. Further investigation is warranted because it is speculative whether the increase in NICT and costs results in clinical benefit after ACS.
尽管急性冠状动脉综合征（ACS）后进行适当的非侵入性心脏检查（NICT）可提供有用的预后信息，但不恰当的使用会导致现有医疗资源的低效消耗。通过使用艾伯塔省当代急性冠状动脉综合征患者侵入性治疗策略（COAPT）登记系统，我们评估了ACS后1年内出院患者NICT的使用情况及成本。
纳入2004/2005年至2015/2016年期间在艾伯塔省因初步诊断为ACS而出院的所有患者。NICT（负荷试验[±成像]和非负荷成像检查）的频率通过关联的省级数据库确定。成本从艾伯塔省医疗保险计划医疗程序清单中获取。
在55516例ACS患者中，30760例至少进行了1次NICT（55.4%），其中13505例（24.3%）在1年内进行了>1次NICT。NICT的时间趋势随时间增加（负荷试验：趋势<0.001；非负荷成像检查：趋势<0.001）。NICT最常发生在出院后的前4个月内（负荷试验在2个月时；非负荷成像检查在3 - 4个月时）。在2015/2016年，NICT的总估计成本为135万美元，较2004/2005年（110万美元）增加了22.4%（P<0.001），而同期ACS的发病率有所下降（P<0.008）。
ACS后1年的NICT使用率较高且随时间增加。NICT的估计成本似乎与ACS的增长不成比例地上升。鉴于NICT及成本的增加是否会给ACS后带来临床益处尚不确定，因此有必要进行进一步调查。
