Papachristidis Alexandros, Vaughan George Frederick, Denny Sarah J, Akbari Tamim, Avornyo Edith, Griffiths Tracey, Saunders Emma, Byrne Jonathan, Monaghan Mark J, Al Fakih Khaled
Cardiology, King's College Hospital NHS Foundation Trust, London, UK
Cardiovascular Division, King's College London, London, United Kingdom.
Open Heart. 2020 May;7(1). doi: 10.1136/openhrt-2019-001081.
Patients with de novo chest pain are usually investigated non-invasively. The new UK-National Institute for Health and Care Excellence (NICE) guidelines recommend CT coronary angiography (CTCA) for all patients, while European Society of Cardiology (ESC) recommends functional tests. We sought to compare the clinical utility and perform a cost analysis of these recommendations in two UK centres with different primary investigative strategies.
We compared two groups of patients, group A (n=667) and group B (n=654), with new onset chest pain in two neighbouring National Health Service hospitals, each primarily following either ESC (group A) or NICE (group B) guidance. We assessed the clinical utility of each strategy, including progression to invasive coronary angiography (ICA) and revascularisation. We present a retrospective cost analysis in the context of UK tariff for stress echo (£176), CTCA (£220) and ICA (£1001). Finally, we sought to identify predictors of revascularisation in the whole population.Baseline characteristics in both groups were similar. The progression to ICA was comparable (9.9% vs 12.0%, p=0.377), with similar requirement for revascularisation (4.0% vs 5.0%.; p=0.532). The average cost of investigations per investigated patient was lower in group A (£279.66 vs £325.77), saving £46.11 per patient. The ESC recommended risk score (RS) was found to be the only predictor of revascularisation (OR 1.05, 95% CI 1.04 to 1.06; p<0.001).
Both NICE and ESC-proposed strategies led to similar rates of ICA and need for revascularisation in discrete, but similar groups of patients. The SE-first approach had a lower overall cost by £46.11 per patient, and the ESC RS was the only variable correlated to revascularisation.
新发胸痛患者通常接受非侵入性检查。英国国家卫生与临床优化研究所（NICE）的新指南建议对所有患者进行CT冠状动脉造影（CTCA），而欧洲心脏病学会（ESC）则推荐功能测试。我们试图比较这两种建议在英国两个采用不同主要检查策略的中心的临床效用并进行成本分析。
我们比较了两组新发胸痛患者，A组（n = 667）和B组（n = 654），这两组患者来自两家相邻的国民健康服务医院，每家医院分别主要遵循ESC（A组）或NICE（B组）的指导。我们评估了每种策略的临床效用，包括进展为侵入性冠状动脉造影（ICA）和血运重建。我们在英国应激超声（176英镑）、CTCA（220英镑）和ICA（1001英镑）收费标准的背景下进行了回顾性成本分析。最后，我们试图确定整个人群血运重建的预测因素。两组的基线特征相似。进展为ICA的情况相当（9.9%对12.0%，p = 0.377），血运重建的需求相似（4.0%对5.0%；p = 0.532）。A组每位接受检查患者的平均检查成本较低（279.66英镑对325.77英镑），每位患者节省46.11英镑。发现ESC推荐的风险评分（RS）是血运重建的唯一预测因素（OR 1.05，95%CI 1.04至1.06；p<0.001）。
NICE和ESC提出的策略在不同但相似的患者群体中导致了相似的ICA发生率和血运重建需求。先进行应激超声检查的方法总体成本较低，每位患者低46.11英镑，并且ESC RS是与血运重建相关的唯一变量。
