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Computed tomography coronary angiography for patients with heart failure (CTA-HF): a randomized controlled trial

Benjamin J W Chow1,2, Doug Coyle3, Alomgir Hossain1,3

  • 1Department of Medicine (Cardiology), The University of Ottawa Heart Institute and University of Ottawa, 40 Ruskin Street, Ottawa, ON K1Y 4W7, Canada.

European Heart Journal. Cardiovascular Imaging
|June 27, 2020
PubMed

Insights

Coronary computed tomography angiography (CCTA) did not show statistically significant cost differences compared to invasive coronary angiography (ICA) for diagnosing heart failure. Both diagnostic strategies yielded similar clinical outcomes and quality of life.

Area of Science:

  • Cardiology
  • Diagnostic Imaging
  • Health Economics

Background:

  • Heart failure (HF) of unknown etiology necessitates diagnostic investigation.
  • Invasive coronary angiography (ICA) is a standard diagnostic tool for HF patients.
  • Coronary computed tomography angiography (CCTA) presents a potential non-invasive, cost-effective alternative.

Purpose of the Study:

  • To evaluate the financial impact of using CCTA as an initial diagnostic strategy for patients with heart failure of unknown etiology.
  • To compare the cost-effectiveness of CCTA versus ICA in diagnosing the cause of heart failure.

Main Methods:

  • A multicentre, international randomized controlled trial involving 246 patients with HF of unknown etiology.
  • Primary outcome: cost comparison between CCTA and ICA strategies at 12 months.
  • Secondary outcomes: clinical events and quality of life measures; intention-to-diagnose and as-tested analyses performed.

Main Results:

  • The cost of CCTA trended lower than ICA (CDN -$871).
  • An 'as-tested' analysis indicated a decrease in healthcare costs with CCTA (CDN -$2932).
  • No significant differences were observed in composite clinical outcomes or quality of life between the CCTA and ICA groups.

Conclusions:

  • In patients with heart failure of unknown etiology, the costs associated with CCTA and ICA diagnostic strategies were not statistically different.
  • CCTA is a viable non-invasive alternative for investigating heart failure of unknown etiology, with comparable clinical outcomes to ICA.
Abstract

Keywords:
coronary CT angiographycost-effectivenessheart failurerandomized controlled trial

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