DISCHARGE: Cost effectiveness of using Coronary computed tomography angiography (CTA) as diagnostic test for Coronary Artery Disease (CAD)
DISCHARGE: Cost effectiveness of using Coronary computed tomography angiography (CTA) as diagnostic test for Coronary Artery Disease (CAD).
Coronary artery disease (CAD) is the main cause of death in high-income countries. The World Health Organization (WHO) estimates there will be about 20 million deaths from cardiovascular reasons in 2015, accounting for 30 percent of all deaths worldwide. Number of deaths caused by coronary heart disease in Europe reaches 1.8 million per year. In addition to that, CAD and the necessary medical treatments lower the patients´ health related quality of life (HRQoL).
Invasive coronary angiography (ICA) is the reference standard for the diagnosis of CAD and allows immediate therapy. However, only 40% of patients undergoing ICA actually have obstructive CAD, and ICA has relatively rare but considerable risks. Coronary computed tomography angiography (CTA) is the most accurate non-invasive diagnostic test for CAD currently available. CTA may become the most effective strategy to reduce the about 2 million annual negative ICAs in Europe by enabling early and safe discharge of the majority of patients with an intermediate risk of CAD.
To evaluate this, the DISCHARGE project, implemented by a multinational European consortium, has been designed. The core of the project is the DISCHARGE pragmatic randomised controlled trial (RCT). The trial will include 23 clinical sites from 18 European countries ensuring broad geographical representation. The primary hypothesis will be that CTA is superior to ICA for major adverse cardiovascular events (cardiovascular death, nonfatal myocardial infarction and stroke) after a maximum follow-up of 4 years in a selected broad population of stable chest pain patients with intermediate pre-test likelihood of CAD.
In addition to clinical outcomes this project will compare the cost-effectiveness of coronary CTA with other imaging modalities used in coronary artery disease.
The project is funded by EU FP7.
Contact: Hans Keiding and Karsten Vrangbæk