Key result
Accelerated outpatient CCTA pathway linked to ~78% lower diagnostic costs versus inpatient angiography.
Why the study?
Emergency chest pain presentations place a substantial burden on healthcare resources, prompting evaluation of the cost impact of an accelerated outpatient CCTA-based diagnostic pathway versus inpatient ICA for acute ED presentations with suspected CAD.
Does an accelerated outpatient CCTA-based diagnostic pathway reduce diagnostic costs and hospital utilization in stable adult ED patients with symptoms suggestive of CAD compared to inpatient admission for ICA?
Observational (n=745)
No
Does an accelerated outpatient CCTA-based diagnostic pathway reduce diagnostic costs and hospital utilization in stable adult ED patients with symptoms suggestive of CAD compared to inpatient admission for ICA?
Effect estimate: 78% reduction
Absolute Event Rate: 854% vs 3844%
Implementing an accelerated outpatient CCTA-based diagnostic pathway for low-risk chest pain patients in the emergency department significantly reduces diagnostic costs and hospital length of stay without compromising short-term safety.
CCTA pathway was associated with lower costs in low-risk ED chest pain; leaves open need for RCTs before practice change.
Background:Emergency chest pain presentations represent a substantial burden on healthcare resources. The use of coronary computed tomography angiography (CCTA) has been shown to be safe and associated with reduced costs in stable outpatients referred for invasive coronary angiography (ICA). The history, electrocardiogram, age, risk factors, troponin (HEART) risk assessment score is used to risk-stratify patients with undifferentiated chest pain. We sought to evaluate the cost impact of an accelerated outpatient CCTA-based diagnostic pathway compared with inpatient ICA for the investigation of patients presenting acutely to the emergency department (ED) with symptoms suggestive of coronary artery disease (CAD) at a tertiary referral centre. Methods:We performed a comparative cost analysis based on retrospective observational data including stable adult ED patients who presented in 2023.Results:369 patients underwent outpatient CCTA and 376 were admitted for ICA. The median time to outpatient CCTA was 14 days (interquartile range (IQR) 5–24). Use of the CCTA-based pathway was associated with a 78% reduction in diagnostic pathway costs (€2990 per patient), when compared to admission for ICA, for the investigation of lower-risk individuals, with no increase in 30-day mortality or myocardial infarction. Patients referred for outpatient CCTA had a significantly shorter median length-of-stay compared with those admitted for ICA (6.5 hours (IQR 5.0–9.0) vs. 5 days (IQR 3.0–14.9); p < 0.05). Conclusions:Use of an accelerated outpatient CCTA-based diagnostic pathway for low-risk chest pain patients in the ED was associated with substantial cost savings and reduced hospital utilization without evidence of compromised short-term safety.
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Karlsson et al. (2026) conducted an observational in Low-risk chest pain suggestive of coronary artery disease (n=745). Accelerated outpatient CCTA-based diagnostic pathway vs. Inpatient admission for invasive coronary angiography (ICA) was evaluated on Diagnostic pathway costs per patient (in Euros) (78% reduction). An accelerated outpatient CCTA-based diagnostic pathway for low-risk chest pain reduced diagnostic costs by 78% (€2990 per patient) compared to inpatient admission for invasive coronary angiography.
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