Cardiovascular Diseases and Cardiac Surgery

Sept. 27, 2023

There is considerable financial burden on the health-care system linked to the diagnosis and treatment of patients with chest pain. Angina and nonobstructive coronary artery disease (ANOCA) is common, is associated with adverse cardiovascular events, and may lead to repeat testing or hospitalizations. Coronary reactivity testing (CRT) achieves diagnostic certainty in patients with ANOCA; however, its financial effect on patients had not been studied. The goal of this Mayo Clinic study, published in Circulation: Cardiovascular Interventions, was to assess the effect of CRT on healthcare-related costs in patients with ANOCA.

Patients with ANOCA who underwent diagnostic coronary angiography (CAG) and CRT (CRT group) were matched to controls who had similar presentations but only underwent CAG without CRT (CAG group). Standardized inflation-adjusted costs were collected and compared between the two groups on an annual basis for two years post the index date (CRT or CAG).

The study included 207 patients each in the CRT and CAG groups. The average patient age was 52.3 ± 11.5 years and 76% were female. The total cost was significantly higher in the CAG group compared with the CRT group: $37,804 ($26,933 to $48,674) versus $13,679 ($9,447 to $17,910); P < 0.001. When costs were itemized and divided based on the Berenson-Eggers Type of Service categorization, the largest cost difference occurred in imaging (any type, including CAG; P < 0.001), procedures (for example, percutaneous coronary intervention, coronary artery bypass grafting or thrombectomy; P = 0.001) and tests (for example, blood tests, ECG; P < 0.001).

In this retrospective observational study, assessment of CRT in patients with ANOCA was associated with significantly reduced annual total costs and healthcare use. Therefore, the study may support the integration of CRT into clinical practice.

For more information

Ahmad A, et al. Coronary reactivity assessment is associated with lower health care-associated costs in patients presenting with angina and nonobstructive coronary artery disease. Circulation: Cardiovascular Interventions. 2023;16:e012387.

Refer a patient to Mayo Clinic.