The safety, efficacy and cost-effectiveness of stress echocardiography in patients with high pretest probability of coronary artery disease

Papachristidis, Alexandros; Demarco, Daniela Cassar; Roper, Damian; Tsironis, Ioannis; Papitsas, Michael; Byrne, Jonathan; Alfakih, Khaled; Monaghan, Mark

doi:10.1136/openhrt-2017-000605

Cited by 2 publications

(2 citation statements)

References 12 publications

(9 reference statements)

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“…Only 1 individual was diagnosed with high PTP, which also seems to be reasonable in terms of incident risk and direct qualification for invasive measures. However, Papachristidis et al 11 proved that SE can also influence this group of patients. In "only" 41% of those with high PTP was the SE score positive; 57% of them were subjected to coronary angiography and 24.6% were treated with PCI.…”

Section: Discussionmentioning

confidence: 98%

Prospective multicenter Polish Stress Echocardiography Registry (PolStress-Echopro) – the role in clinical practice

Gąsior¹,

Lasota²,

Zaborska³

et al. 2019

Adv Clin Exp Med

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Background. Stress echocardiography (SE) is becoming an increasingly frequently performed diagnostic examination in Poland. After the published retrospective PolSTRESS Registry, this prospective study is the first one available so far. Objectives. The aim of the study was to analyze SE tests, taking into account the clinical characteristics of the patients, indications, applied protocols, and diagnostic and therapeutic decisions. Material and methods. Reference cardiological centers in Poland were asked for a 1-month prospective analysis of the data obtained. The study included 189 SE examinations. To evaluate coronary artery disease (CAD) (178 tests), all 17 centers performed dobutamine SE (DSE) (100%), 3 centers (17%) performed pacing, while cycle ergometer and treadmill SE were performed by 1 (5%) and 2 (11%) centers, respectively. In patients with valvular heart disease (VHD) (11 tests), 3 centers (16%) performed SE to evaluate low-flow/ low-gradient aortic stenosis (AS), 4 (22%) in asymptomatic AS and 1 (5%) to evaluate mitral regurgitation. Results. For CAD assessment, a positive result was found in 37 (20%) patients, negative in 109 (61%) and nondiagnostic in 32 (19%). In the CAD group, coronarography was performed in 41 (23%) people. The analysis of the significance of the SE results for decision-making on interventional measures revealed that 30 patients (from the total study population of 189) were referred for the intervention. Conclusions. The most commonly used SE is the DSE. Negative test results allowed in almost half of the patients to resign from invasive coronarography. Stress echocardiography should be more frequently used in patients with VHD in the qualification for invasive treatment.

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Section: Discussionmentioning

confidence: 98%

Prospective multicenter Polish Stress Echocardiography Registry (PolStress-Echopro) – the role in clinical practice

Gąsior¹,

Lasota²,

Zaborska³

et al. 2019

Adv Clin Exp Med

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“…Stress echocardiography is one of the most widely used functional tests for detecting CAD in the UK [ 9 ] and has been shown to be accurate and cost-effective [ 10 – 14 ]. Additionally, the European Society of Cardiology (ESC) guidelines recommend both non-invasive functional imaging and non-invasive anatomical imaging for diagnosis of severe CAD [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

Real world hospital costs following stress echocardiography in the UK: a costing study from the EVAREST/BSE-NSTEP multi-centre study

Johnson,

Woodward,

McCourt

et al. 2023

Echo Res Pract

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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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The safety, efficacy and cost-effectiveness of stress echocardiography in patients with high pretest probability of coronary artery disease

Cited by 2 publications

References 12 publications

Prospective multicenter Polish Stress Echocardiography Registry (PolStress-Echopro) – the role in clinical practice

Prospective multicenter Polish Stress Echocardiography Registry (PolStress-Echopro) – the role in clinical practice

Real world hospital costs following stress echocardiography in the UK: a costing study from the EVAREST/BSE-NSTEP multi-centre study

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