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

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Duke Health News 919-660-1306

DALLAS, TX -- 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.

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