Quality-of-Life and Economic Outcomes of Assessing Fractional Flow Reserve With Computed Tomography Angiography PLATFORM
Quality-of-Life and Economic Outcomes of Assessing Fractional Flow Reserve With Computed Tomography Angiography PLATFORM
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DOI：
10.1016/j.jacc.2015.09.051
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发表时间：
2015-12-01
影响因子：
24
通讯作者：
Douglas, Pamela S.
中科院分区：
文献类型：
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作者：
Hlatky, Mark A.;De Bruyne, Bernard;Douglas, Pamela S.
背景利用计算机断层扫描(Computer Tomography，FFRCT)估计的血流储备分数可能会改善对胸痛患者的评估。目的研究使用FFRCT评估有可疑冠脉疾病症状的稳定患者的费用和生活质量(QOL)的影响。在每一层中，对连续的观察队列进行常规护理或FRCT评估。在90天的随访中，诊断性测试、侵入性手术、住院和药物治疗的次数乘以美国的成本权重，然后相加得出总的医疗成本。使用西雅图心绞痛问卷、EuroQol和视觉模拟量表评估从基线到90天的生活质量变化。结果在584名患者中，74%的患者有不典型心绞痛，试验前冠心病的概率为49%。在计划中的侵入性层面，接受快速放射治疗的患者的平均成本比常规护理患者低32%(7,343美元对10,734美元；0.0001)。在非侵入性层面，FFRCT患者和常规护理患者的平均成本没有显著差异(2,679美元对2,137美元；p=0.26)。在敏感性分析中，当快速放射治疗的成本权重设置为计算机断层血管成像的7倍时，快速放射治疗组在有创测试层的成本仍低于普通护理组(8,619美元对10,734美元；p<；0.0001)，而在非侵入性测试层，当快速放射治疗的成本权重设置为计算机断层血管成像的一半时，快速放射治疗组的成本高于普通护理组(2,766美元对2,137美元；p=0.02)。在整个研究人群中，每个生活质量得分都有所改善(p<；0.0001)。在非侵入性层面，FRCT患者的生活质量得分比常规护理患者改善得更多：西雅图心绞痛问卷19.5vs11.4p=0.003；EuroQol0.08vs0.03，p=0.002；视觉模拟评分4.1vs2.3p=0.82.在有创队列中，FFRCT和常规护理患者的生活质量改善相似。结论基于FFRCT的评估策略与有创冠状动脉造影术评估相比，在90天内使用更少的资源和更低的成本。与通常的非侵入性检查评估相比，使用FFRCT评估患者的生活质量有更大的改善。(FFRCT的前瞻性纵向试验：结果和资源影响[平台]；NCT01943903)(C)2015年，美国心脏病学会基金会。
BACKGROUND Fractional flow reserve estimated using computed tomography (FFRCT) might improve evaluation of patients with chest pain.OBJECTIVES The authors sought to determine the effect on cost and quality of life (QOL) of using FFRCT instead of usual care to evaluate stable patients with symptoms suspicious for coronary disease.METHODS Symptomatic patients without known coronary disease were enrolled into 2 strata based on whether invasive or noninvasive diagnostic testing was planned. In each stratum, consecutive observational cohorts were evaluated with either usual care or FFRCT. The number of diagnostic tests, invasive procedures, hospitalizations, and medications during 90-day follow-up were multiplied by U.S. cost weights and summed to derive total medical costs. Changes in QOL from baseline to 90 days were assessed using the Seattle Angina Questionnaire, the EuroQOL, and a visual analog scale.RESULTS In the 584 patients, 74% had atypical angina, and the pre-test probability of coronary disease was 49%. In the planned invasive stratum, mean costs were 32% lower among the FFRCT patients than among the usual care patients ($7,343 vs. $10,734 p < 0.0001). In the noninvasive stratum, mean costs were not significantly different between the FFRCT patients and the usual care patients ($2,679 vs. $2,137; p = 0.26). In a sensitivity analysis, when the cost weight of FFRCT was set to 7 times that of computed tomography angiography, the FFRCT group still had lower costs than the usual care group in the invasive testing stratum ($8,619 vs. $10,734; p < 0.0001), whereas in the noninvasive testing stratum, when the cost weight of FFRCT was set to one-half that of computed tomography angiography, the FFRCT group had higher costs than the usual care group ($2,766 vs. $2,137; p = 0.02). Each QOL score improved in the overall study population (p < 0.0001). In the noninvasive stratum, QOL scores improved more in FFRCT patients than in usual care patients: Seattle Angina Questionnaire 19.5 versus 11.4, p = 0.003; EuroQOL 0.08 versus 0.03, p = 0.002; and visual analog scale 4.1 versus 2.3, p = 0.82. In the invasive cohort, the improvements in QOL were similar in the FFRCT and usual care patients.CONCLUSIONS An evaluation strategy based on FFRCT was associated with less resource use and lower costs within 90 days than evaluation with invasive coronary angiography. Evaluation with FFRCT was associated with greater improvement in quality of life than evaluation with usual noninvasive testing. (Prospective Longitudinal Trial of FFRCT: Outcomes and Resource Impacts [PLATFORM]; NCT01943903) (C) 2015 by the American College of Cardiology Foundation.