Abstract 132: Cost-Effectiveness of Stress Echocardiography and Long-Term Outcomes in Framingham Risk Score Stratified Patients with Non-anginal Chest Pain, Normal ECG and Normal Cardiac Biomarkers

Abstract

Background: We investigated cost-effectiveness of stress echocardiography (SE) and long-term outcomes in Framingham risk score (FRS) stratified patients referred for stress testing after having presented with non-anginal chest pain, normal ECG, normal cardiac biomarkers. Material and Methods: Of 619 consecutive patients, 238 patients with complete dataset were divided into groups based on the interquartile range of the FRS (Table). Cost per CAD diagnosis was inferred based on post-test likelihood of CAD assuming accepted clinical practice of cardiac catheterization in patients with a SE demonstrating inducible ischemia. Long-term outcomes were ascertained using the Social Security Death Index and hospital records. Cause of death was identified in all but 3 patients. Chi-square test and analysis of variance were used to analyse categorical and continuous variables. Results: Study population consisted of 48% females, 52+/- 12 years old, 23% diabetics, and 40% current smokers. Intermediate and high FRS patients were more likely to develop ischemia by SE (4% vs. 9% in higher FRS, p<0.05, Table). When post-test likelihood of CAD was considered, four-fold higher relative value units (RVUs) per single case CAD diagnosis was needed in patients with low FRS (Table). No cardiovascular deaths were recorded during the mean follow-up of 60+/-12 months. While FRS≥0.216 was associated with 4-fold higher mortality, it was not affected by stress tests results. Most common causes of death were renal, pulmonary, and hepatic failure. Conclusion: In patients presenting with non-anginal chest pain, normal EKG and normal biomarkers, long-term follow-up suggests very low cardiovascular mortality. In this patient population further stratification by stress testing does not aid in predicting cardiovascular outcomes nor is it cost-efficient. For differences vs. CAD patients: p<0.05; †) p<0.01; ‡) p<0.005; §) p<0.001; blank - NS.