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HowToPreventHeartDisease.com |
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Would CT Scan Benefit Suspected Heart Attack Patients? Chest pain can be a sign of heart attack. Inability to receive appropriate medical help in time can cause damage, deterioration and even death of heart muscles. But chest pain can be due to many other causes too. It is rather difficult even for a physician or medical professional to determine what is causing chest pain and whether it is life threatening. In general, any part of the chest including heart, lungs, muscle, bone and skin can be the cause of the pain. Chest pain might also originate from another part of the body. For instance, stomach or other organs in the belly can also cause chest pain. Statistics showed that more than 90 percent of the 6 million people who go to hospitals each year in the United States with chest pain have medical conditions like indigestion, stress, muscle strain or some other problems but not heart disease. But doctors are afraid that they might miss the ones who do have it, and increasingly using an advanced type of CT scan to identify patients having heart attack. More than 50,000 scans were done in Medicare patients in 2010. CT (computed tomography) scan is a type of X-ray with an injected dye to get detailed views of arteries. Calcium-score screening heart scan, Coronary Computer Tomographic Angiography (CCTA) and Total Body CT scan are few examples of this kind of scan.
A new study, however, claimed that the CT scan might be good for hospitals but not necessarily good for the patients. Researchers from various institutions including Massachusetts General Hospital reported in the July 26, 2012's issue of ‘New England Journal of Medicine’ that these CCTA did reduce time spent in the hospital but did not really save money. The scan not only prompted more tests and questionable treatments but also gave large doses of radiation to people who might be at low risk of heart attack. The radiation from the scan might also put these patients at a higher chance of developing cancer. Researchers enrolled 1,000 patients who went to 1 of the 9 hospitals around the country during regular daytime, weekday hours with chest pain or other possible heart attack symptoms. These patients did not show clear sign of a heart attack on initial tests. Then, they were randomly assigned to further evaluation either with a CCTA or whatever is standard at that hospital like a treadmill or other heart tests. Those given the CT scans spent an average of 23 hours in the hospital while others spent 30 hours. 47 percent of the patients given the scans were sent home directly from the emergency room and only 12 percent were admitted. There is no doubt that identifying the underlying cause of chest pain is more quickly with CT scans. This could allow medical care providers to better allocate their limited resources to those patients who really need the treatment while letting others go home faster. Nevertheless, the average cost of care was $4,289 for patients in the CT group and $4,060 for the others, despite spending 7 hours less in the hospital. 8 percent of both groups turned out to have heart disease but only 5 of the 1,000 had had a heart attack. 29 patients in the CT group ended up getting a heart bypass or artery-opening angioplasty and stent procedures compared to only 18 patients in the usual care group. Clearly, overtreatment was evident. Meanwhile, those given CT scans had nearly tripled the amount of radiation: about 14 millisieverts (a measure of dose) versus less than 5 millisieverts for the others. Exposures of 10 millisieverts have been projected to lead to 1 death from cancer per 2,000 persons. Many factors, including a patient's gender, age, and history of chest pain or other illnesses like diabetes, have long been used to predict heart risk provided that the initial EKG and blood work suggest no problem. It is the belief of the researchers that routine testing using CT scan in the emergency department should be avoided for patients with a low-to-intermediate risk.
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