Original ResearchThe Use and Efficacy of FFR-CT: Real-World Multicenter Audit of Clinical Data With Cost Analysis
Central Illustration
Section snippets
Methods
We undertook a multicenter audit of FFR-CT performed as part of the ITP program in England between April 2018 and March 2021. Cardiologists and radiologists from hospital trusts in England using FFR-CT were invited to participate (Supplemental Table 1). Because this study was a clinical audit involving a retrospective review of observational data, it was exempt from the need for ethical approval. However, the participating centers registered the project with their quality and safety
Results
Twelve hospital trusts in England contributed to this study, with 2,298 CCTA studies (10.9%) sent for FFR-CT analysis. The number of cases contributed by each center, the time over which the scans were performed, and the total number of CCTAs performed during the same period are shown in Supplemental Table 1.
Baseline clinical and imaging data are shown in Table 1. The mean age of the patients was 61.4 ± 10.0 years (range: 20-91 years), and 62% were male.
Discussion
This observational overview of real-world clinical practice in England reveals that, against the recommendations made by NICE, a quarter of CCTA patients referred for FFR-CT did not have stable chest pain and only 40% had stenosis of uncertain functional significance. Moreover, the PPV of FFR-CT was as low at 33% to 50%, depending on the range of CCTA stenosis considered. Cost analysis suggests that the use of FFR-CT is more expensive than stress imaging alternatives.
Based on the available
Conclusions
To our knowledge, this is the first multicenter audit of the use of FFR-CT against national clinical standards. We found that of the 11% of CCTAs analyzed for FFR-CT, 23% did not have stable chest pain, and 60% did not have stenosis of uncertain significance (50%-69%). The PPV and NPV of FFR-CT in real-world practice were lower than values obtained from published trials, and there was no outcome benefit. Cost analysis revealed that the use of FFR-CT may be more expensive than stress imaging
Funding Support and Author Disclosures
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Acknowledgments
The authors are grateful to the British Association of Cardiologists of Indian Origin, who supported this audit. The authors acknowledge the contribution of Paul Bassett for statistical analysis and that of Ana Duarte, Research Fellow at the Centre of Health Economics, University of York, United Kingdom, for the health economic analysis.
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