Economic Outcomes With Anatomical Versus Functional Diagnostic Testing for Coronary Artery Disease
Authors: Daniel B. Mark, Pamela S. Douglas, Melanie R. Daniels
Journal: Annals of Internal Medicine (2016)

Letters20 December 2016Economic Outcomes With Anatomical Versus Functional Diagnostic Testing for Coronary Artery DiseaseDaniel B. Mark, MD, MPH, Pamela S. Douglas, MD, and Melanie R. Daniels, BADaniel B. Mark, MD, MPHFrom Duke University Medical Center, Durham, North Carolina., Pamela S. Douglas, MDFrom Duke University Medical Center, Durham, North Carolina., and Melanie R. Daniels, BAFrom Duke University Medical Center, Durham, North Carolina.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/L16-0482 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:Dr. Martin makes several interesting points. PROMISE was a pragmatic randomized trial designed to assess the outcomes of 2 diagnostic strategies in symptomatic patients: initial use of CTA or of functional testing (a composite of exercise ECG testing, stress nuclear testing, or stress echocardiography, with the choice of test left up to the managing physician) (1, 2). It was not designed or powered to compare each functional testing option individually against CTA. Exercise ECG testing without imaging is clearly less expensive than CTA, but PROMISE was not designed to prove that it was clinically equivalent or better. The ...References1. Douglas PS, Hoffmann U, Lee KL, Mark DB, Al-Khalidi HR, Anstrom K, et al; PROMISE investigators. PROspective Multicenter Imaging Study for Evaluation of chest pain: rationale and design of the PROMISE trial. Am Heart J. 2014;167:796-803. [PMID: 24890527] doi:10.1016/j.ahj.2014.03.003 CrossrefMedlineGoogle Scholar2. Douglas PS, Hoffmann U, Patel MR, Mark DB, Al-Khalidi HR, Cavanaugh B, et al; PROMISE Investigators. Outcomes of anatomical versus functional testing for coronary artery disease. N Engl J Med. 2015;372:1291-300. [PMID: 25773919] doi:10.1056/NEJMoa1415516 CrossrefMedlineGoogle Scholar3. SCOT-HEART investigators. CT coronary angiography in patients with suspected angina due to coronary heart disease (SCOT-HEART): an open-label, parallel-group, multicentre trial. Lancet. 2015;385:2383-91. [PMID: 25788230] doi:10.1016/S0140-6736(15)60291-4 CrossrefMedlineGoogle Scholar4. Squires D, Anderson C. U.S. health care from a global perspective: spending, use of services, prices, and health in 13 countries. The Commonwealth Fund. 8 October 2015. Accessed at www.commonwealthfund.org/publications/issue-briefs/2015/oct/us-health-care-from-a-global-perspective on 14 November 2016. Google Scholar Author, Article, and Disclosure InformationAffiliations: From Duke University Medical Center, Durham, North Carolina.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M15-2639. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoEconomic Outcomes With Anatomical Versus Functional Diagnostic Testing for Coronary Artery Disease Daniel B. Mark , Jerome J. Federspiel , Patricia A. Cowper , Kevin J. Anstrom , Udo Hoffmann , Manesh R. Patel , Linda Davidson-Ray , Melanie R. Daniels , Lawton S. Cooper , J. David Knight , Kerry L. Lee , Pamela S. Douglas , and Economic Outcomes With Anatomical Versus Functional Diagnostic Testing for Coronary Artery Disease Wade H. Martin III Metrics Cited byRecent clinical trials support continued emphasis on patient-first over modality-first approaches to initial test selection in patients with stable ischemic heart diseaseSCCT 2021 Expert Consensus Document on Coronary Computed Tomographic Angiography: A Report of the Society of Cardiovascular Computed TomographyClinical and Economic Implications of Inconclusive Noninvasive Test Results in Stable Patients With Suspected Coronary Artery DiseaseShould NICE guidelines be universally accepted for the evaluation of stable coronary disease? A debateCardiovascular computed tomographic angiography: Entering into the 5th stage 20 December 2016Volume 165, Issue 12Page: 891KeywordsComputed axial tomographyDisclosureEchocardiographyExerciseHealth careHeartMyocardial infarctionRandomized trialsStable coronary artery disease ePublished: 20 December 2016 Issue Published: 20 December 2016 Copyright & PermissionsCopyright © 2016 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...