Skip to comments.The Promise and Peril of Heart Scans
Posted on 11/20/2004 8:13:49 PM PST by neverdem
A seductive new diagnostic technology may be coming to a medical center near you. It is an advanced heart scanner that can produce sharply detailed pictures of every clogged artery that might be threatening to cause a heart attack. Some experts expect it to revolutionize the practice of cardiology, while others are warning that it could bankrupt the health care system. Even discounting for hyperbole on both sides, it will be important to ensure that this technology is used only on the most appropriate patients and not promoted willy-nilly for every anxious man or woman eager to exploit the latest medical fad.
As described by Gina Kolata in Wednesday's Times, the technology is a vastly more powerful version of the CT scanners that have long been used to construct X-ray images of various organs in the body. Cardiologists have been frustrated that those scanners produce only blurry images of the fast-beating heart and its arteries, but now, by adding a lot more detectors, the new machines are able to produce pictures of startling detail and clarity. In the long run, the new scanners could replace the stress test, which some patients find too arduous to perform, and the much more expensive angiogram, an invasive procedure that requires threading a catheter from the groin to the heart with the patient under sedation. Heart scans are expected to cost about $700, compared with roughly $4,000 for an angiogram.
From a patient's viewpoint, the heart scans have a lot to recommend them. They take seconds to conduct and require no recovery time, whereas an angiogram takes 45 minutes and requires hours of recuperation. The scans can also spot danger spots in the arteries that might be missed by an angiogram. The downsides are that heart scans subject a patient to far more radiation than most diagnostic procedures, and they are quite apt to spot things that are of no medical consequence but that one might feel compelled to do something about. In the end, the patient might undergo additional tests and procedures - all of them carrying some degree of risk - to eliminate a potential problem that did not really need to be fixed.
Used sensibly, heart scans could save the health care system substantial money. In emergency rooms, for example, heart scans could help doctors determine quickly whether a patient complaining of chest pains is suffering from a heart attack that requires costly hospitalization or a pulled muscle that can be nursed at home. Used recklessly, however, the scans could break the medical bank. Leading cardiologists fear pressure to use the scans as a broad screening tool to look for problems in people who have no symptoms and no particular risk of a heart attack, thus accelerating the relentless increase in medical costs. Professional groups will need to issue detailed guidelines on who would truly benefit from the new scanners, and insurers should limit reimbursements to those who meet the guidelines. Anyone else who wants access to a technology that might offer no benefit and carries a slight risk of harm ought to pay for the privilege.
MRI's were originally restricted to one unit per state and cost was exhorbitant. The more MRI's, the more use. Costs were reduced. Same will be true with the scanner. The more it is used even for non necessary items will reduce the cost per unit.
I don't quite agree with the chickern little that a faster , less stressful, more accurate diagnostic tool will be bad.
And the technology gets refined (contrast agents, "open" MRI etc) and better and cheaper...
FReepmail me if you want on or off my health and science ping list.
I had one. I paid for it 100% out of my own pocket. Please explain to me, NYT, how this will "break the medical bank"?
Then why do they cost $700?
Because its NEW.. and the medical establishment runs on MONEY.. not the mythical hypocratism of legend..
There are now 64 detectors/unit. Two years ago I was charged $1070 for a CT scan of the abdomen and pelvis.