For High-Volume Chest Pain Centers, Aggressive Use Of Nuclear Imaging Technology Saves Money, Shortens Hospital Says

November 10, 1998

DALLAS -- Hospital emergency departments that see many potential heart attack patients could reduce health care costs and patient stays by using nuclear imaging technologies in a more aggressive manner to identify patients at the highest risk for heart attack, a pilot study has shown.

An economic analysis demonstrated that patient costs for care using a diagnostic technique called "perfusion imaging" were almost half that of patients treated in the conventional manner. They also had an almost threefold reduction in the total length of stay.

While the study involved 46 patients largely seen at a single medical facility in Jacksonville, Fla., Eric Eisenstein, assistant research professor at the Duke Clinical Research Institute (DCRI), said the results are dramatic enough to warrant a larger clinical trial.

"By using existing technologies in a novel way, we were able to demonstrate significant cost savings," Eisenstein said. "At the same time, the use of these technologies should help give emergency room physicians greater confidence in the course of action they choose for their patients."

Eisenstein prepared the results of his economic analysis for presentation Tuesday (Nov. 10) at the 71st scientific sessions of the American Heart Association meeting. Dr. Stephen Stowers, a Florida cardiologist, organized the pilot study and was responsible for the care of the study's patients. Usually, when patients come to emergency rooms with chest pain, they are given a standard electrocardiogram (ECG) and blood is drawn to measure levels of heart enzymes in the blood.

However, there are times when the results of these tests are inconclusive, leaving physicians with little guidance as to what should be done next. Often, not wanting to take unnecessary risks, physicians admit these patients to the hospital for observation or further testing.

In the study, half the patients received a SPECT (single photon emission computed tomography) imaging study, in which special cameras rotate around the body recording the emssions of a radioactive tracer. Computers then convert these slices into cross-sectional images. If the SPECT test showed no damaged heart muscle, patients then received a standard exercise stress test. If this exercise stress test also proved negative, the patient was discharged.

"These tests can give physicians who are uncertain of which course to take the confidence to discharge those patients who don't need hospitalization," Eisenstein said. "It also finds those patients who really should receive further treatment."

For those patients in the study who received conventional care, the total average hospital costs were $9,054; for those who underwent the perfusion imaging guided care, the cost was $4,620. In terms of total length of stay in the hospital, conventionally treated patients spent 3.8 days in the hospital; perfusion imaging guided patients spent 1.4 days in hospital.

Eisenstein pointed out that this strategy is not appropriate for all hospitals. In order for it to be cost-effective, hospitals not only need to see a high volume of heart patients, but they must have the nuclear imaging facilities available 24 hours a day.

Also involved in the study were, from Duke, Dr. Galen Wagner and Lai Lam; Dr. Franz Wackers and Donna Natale from Yale University; and Dr. Stephen Stowers, St. Luke's Hospital, Jacksonville, Fla.
-end-


Duke University Medical Center

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