platform: economic and quality of life outcomes of an ffr ct diagnostic strategy in suspected cad...
TRANSCRIPT
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PLATFORM: Economic and Quality of Life Outcomes of an FFRCT Diagnostic Strategy in
Suspected CAD
Mark A Hlatky, Bernard De Bruyne, Gianluca Pontone, Manesh Patel, Alan Wilk, Campbell Rogers, Pamela Douglas,
PLATFORM Investigators
Supported by HeartFlow, Inc.
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Disclosure Statement of Financial Interest
Within the past 12 months, I or my spouse/partner have had a financial interest/arrangement or affiliation with the organizations listed below.
Affiliation/Financial Relationship Company
• Grant/Research Support HeartFlow, Inc
• Consulting Fees/Honoraria Blue Cross Blue Shield
J Am Coll Cardiol
Acumen, Inc
• Royalty Income Up-to-Date
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Background and Aim Optimal evaluation of new onset stable chest pain is
uncertain
CTA provides anatomic information, and is highly sensitive, but does not define the functional significance of lesions
Fractional flow reserve can now be estimated from standard CTA data (FFRCT)
In PLATFORM, use of FFRCT reduced rate of invasive angiography without obstructive CAD by 61%
AIM: Assess economic and QOL outcomes of using CTA with FFRCT instead of usual care
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Study Design
Patients with stable symptoms, intermediate probability of CAD, and no established CAD diagnosis
Referred for planned invasive or planned non-invasive evaluation at 11 European centers
Consecutive cohorts: usual care, CTA + FFRCT
Resource use over 90 days, cost weights from US Medicare
QOL changes from baseline to 90 days with Seattle Angina Questionnaire, EuroQOL
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Baseline Characteristics
Planned Planned Invasive Non-Invasive Usual Care FFRCT Usual Care FFRCT (N=187) (N=193) (N=100) (N=104)
Age 63 61 58 59
Male 58% 62% 66% 58%
Atypical Pain 65% 74% 91% 77%
Prior Testing 49% 52% 0% 5%
Prob CAD 52% 49% 45% 45%
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Key Resource Use Within 90 Days
Planned Planned Invasive Non-Invasive Usual
Care FFRCT Usual Care FFRCT (N=187) (N=193)
(N=100) (N=104)
Stress Tests 4 9 51 9
CTA 1 193 60 104
FFRCT 0 117 0 60
Dx Angio 153 37 9 10
PCI 44 51 4 9
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Costs Over 90 Days
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Sensitivity Analysis No Medicare cost-weight yet for FFRCT
• Primary analysis used $0 to estimate cost offsets
• Multiples of CTA cost weight in sensitivity analysis
Scenario Usual Care FFRCT P
Invasive
0 x CTA $10,734 $7,343<0.0001
7 x CTA $10,734 $8,619<0.0001
Non-Invasive
0 x CTA $ 2,137 $2,679 0.26
0.5 x CTA $ 2,137 $2,766 0.02
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Changes in SAQ, Baseline to 90 Days
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Limitations
Not randomized or blinded
Conducted in Europe, not in the US
Only Medicare price weights used
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Conclusions
In symptomatic patients with intermediate probability of CAD, evaluation strategies based on FFRCT had
• Lower cost than invasive coronary angiography
• Greater improvement in QOL than usual non-invasive testing
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Published today in J Am Coll Cardiol