Author + information
- Received September 16, 2015
- Revision received September 25, 2015
- Accepted September 25, 2015
- Published online December 1, 2015.
- Mark A. Hlatky, MD∗∗ (, )
- Bernard De Bruyne, MD, PhD†,
- Gianluca Pontone, MD, PhD‡,
- Manesh R. Patel, MD§,
- Bjarne L. Norgaard, MD‖,
- Robert A. Byrne, MB BCh, PhD¶,
- Nick Curzen, BM (Hons), PhD#,
- Ian Purcell, MD∗∗,
- Matthias Gutberlet, MD††,
- Gilles Rioufol, MD‡‡,
- Ulrich Hink, MD§§,
- Herwig Walter Schuchlenz, MD‖‖,
- Gudrun Feuchtner, MD¶¶,
- Martine Gilard, MD##,
- Daniele Andreini, MD‡,
- Jesper M. Jensen, MD‖,
- Martin Hadamitzky, MD¶,
- Alan Wilk, BS∗∗∗,
- Furong Wang, MD∗∗∗,
- Campbell Rogers, MD∗∗∗,
- Pamela S. Douglas, MD§,
- PLATFORM Investigators
- ∗Department of Health Research and Policy and Department of Medicine, Stanford University School of Medicine, Stanford, California
- †Cardiovascular Center Aalst, Aalst, Belgium
- ‡Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
- §Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
- ‖Department of Cardiology, Aarhus University Hospital, Aarhus Skejby, Denmark
- ¶Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- #University Hospital Southampton NHS Trust, Southampton, United Kingdom
- ∗∗Freeman Hospital, Newcastle upon Tyne, United Kingdom
- ††University of Leipzig Heart Centre, Leipzig, Germany
- ‡‡Hospices Civils de Lyon and Laboratoire de Recherche en Cardiovasculaire, Métabolisme, Diabétologie et Nutrition, Institut National de la Santé et de la Recherche Médicale, Lyon, France
- §§Cardiology Department, Johannes Gutenberg University Hospital, Mainz, Germany
- ‖‖LKH Graz West, Graz, Austria
- ¶¶Department of Radiology, Innsbruck Medical University, Innsbruck, Austria
- ##Department of Cardiology, Cavale Blanche Hospital, Brest, France
- ∗∗∗HeartFlow, Inc., Redwood City, California
- ↵∗Reprint requests and correspondence:
Dr. Mark A. Hlatky, Stanford University School of Medicine, HRP Redwood Building, Rm. T150, 259 Campus Drive, Stanford, California 94305-5405.
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)
- coronary angiography
- coronary artery disease
- cost comparison
- myocardial fractional flow reserve
- quality of life
- stress test
Supported by HeartFlow, Inc., Redwood City, California. Dr. Hlatky has received research grants from HeartFlow. Dr. De Bruyne has received grants from HeartFlow, Abbott, St. Jude Medical, and Medtronic; and has received consultant’s fees (to his institution) from St. Jude Medical, Boston Scientific, and Opsens; and holds equities in Omega Pharma, Siemens, Edwards Lifesciences, GE, Sanofi, HeartFlow, and Bayer. Dr. Pontone has received institutional grants and fees from GE Healthcare, Medtronic, and Bracco. Dr. Patel has received grants from HeartFlow, Jansen, Johnson & Johnson, AstraZeneca, NHLBI, and AHRQ; and has received personal advisory board fees from AstraZeneca, Genzyme, Jansen, Bayer, and Merck. Dr. Norgaard has received grants from Edwards Lifesciences. Dr. Byrne has received grants from HeartFlow; and has received speaker fees from B. Braun, Biotronik, and Boston Scientific. Dr. Curzen has received grants from HeartFlow, Boston Scientific, Medtronic, Haemonectics, and St. Jude Medical; has received honoraria or consulting fees from Haemonectics, HeartFlow, and Lilly/Daiichi Sankyo; has received speaker fees from HeartFlow and St. Jude Medical; and has received travel sponsorship from St. Jude Medical, Abbott Vascular, and Biosensors. Dr. Rioufol has received grants from HeartFlow; and has received personal fees from St. Jude Medical and Boston Scientific. Dr. Feuchtner has received research support from Medtronic. Dr. Gilard has received travel sponsorship from Abbott, AstraZeneca, Biotronik, Boston Scientific, Daiichi-Sankyo, Edwards, Eli Lilly and Company, Medtronic, and Terumo. Dr. Andreini has received grants and personal fees from GE Healthcare. Dr. Hadamitzky has received grants from Siemens Healthcare. Mr. Wilk, Dr. Wang, and Dr. Rogers are employees of HeartFlow. Dr. Douglas has received grants from HeartFlow; and has received other support from GE Medical Systems. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received September 16, 2015.
- Revision received September 25, 2015.
- Accepted September 25, 2015.
- 2015 American College of Cardiology Foundation