Heart Disease UK

Avijit Lahiri, Eric Lim & Vijay D. Anand
What about the economic burden of such an imaging strategy? Since these scans are versatile and many patients can be imaged in the same day, the cost of the test can be relatively low when performed in large volumes ($200 – 300 in the West). Since patients who do not have coronary artery calcification have an excellent outcome (<0.5 percent death rate per year) in a five – year follow up (Shaw and colleagues), using this model, over 50 per cent of the patients with diabetes would then be sent for standard medical treatment, whereas those with higher amounts of coronary artery calcium would undergo further testing (such as myocardial perfusion imaging described earlier). Those with negative tests would then be treated aggressively medically (tablets and the like). However in those with positive tests, opening up the artery physically (so-called coronary angioplasty) or even surgery may be more appropriate. In symptomatic patients, it is possible that using that using these tests can be very coat-effective. For example, patients with chest pain are often investigated using a test called exercise stress testing followed by coronary angiography. In the U.K. (where Dr Lahiri practices), this would cost per patient over ₤1200. If instead CT scanning were used, followed by myocardial perfusion imaging, a back-of-the-envelope calculation shows that it is quite possible to lower the cost by as much as 50 per cent. This translates to over half a million pounds per 1,000 patients.
These developments in the area of early detection of coronary artery disease will be even more exciting once they can be linked to emerging new therapeutic regimes for heart disease. For example, in animal models, early trails by Dr Shaw and colleagues have shown that it may be possible to develop a “vaccine” against heart disease. In the future, this potent combination of technologies, namely, early detection and powerful treatments, may be able to stem the misery of heart disease associated with diabetes.