In order to bring you the best possible user experience, this site uses Javascript. If you are seeing this message, it is likely that the Javascript option in your browser is disabled. For optimal viewing of this site, please ensure that Javascript is enabled for your browser.


The free consultation period for this content is over.

It is now only available year-round to ESC Professional Members, Fellows of the ESC, and Young combined Members

Usefulness of clinical decision support system as tool of good clinical practice in patients at low risk of coronary artery disease. The ARTICA co-operative database.

Session Digital health analysis

Speaker Ervina Shirka

Congress : ESC Congress 2018

  • Topic : e-cardiology / digital health, public health, health economics, research methodology
  • Sub-topic : Digital Health, Other
  • Session type : Moderated Posters
  • FP Number : P280

Authors : M Mazzanti (London,GB), E Shirka (Tirana,AL), F Pugliese (London,GB), H Gjergo (Tirana,AL), A Goda (Tirana,AL), A Pottle (Harefield,GB), E Hasimi (Tirana,AL), SE Deane (London,GB), N Dent (London,GB), N Mackay (London,GB), R Underwood (London,GB)

Authors:
M. Mazzanti1 , E. Shirka2 , F. Pugliese3 , H. Gjergo2 , A. Goda2 , A. Pottle4 , E. Hasimi2 , S.E. Deane5 , N. Dent5 , N. Mackay5 , R. Underwood6 , 1Royal Brompton Hospital - London - United Kingdom , 2University Hospital Center Mother Theresa, Cardiology - Tirana - Albania , 3Barts Health NHS Trust, Cardiac Imaging - London - United Kingdom , 4Harefield Hospital, Nurse Consultant - Harefield - United Kingdom , 5Harefield Hospital, Nurse in Cardiology - London - United Kingdom , 6Imperial College London, RBH Nuclear Medicine - London - United Kingdom ,

Citation:
European Heart Journal ( 2018 ) 39 ( Supplement ), 41-42

Background: The use of decision support systems (DSS) at the point of care may enhance the appropriateness of clinical cardiology versus human physician standard care (STD) bringing evidence-based medicine at the point-of-care.

Purpose: To analyze DSS results vs standard care (STD) in the clinical workflow of patients (pts) at low, low-to-intermediate pre test likelihood (L-LI) of coronary artery disease (CAD).

Methods: 692 pts (403 males and 289 females, age 57±7 years) with L-LI of CAD were referred for stable chest pain evaluation over a 16 month period in three different hospitals. A browsing computerized automated DSS and a human cardiologist STD were applied during the same day visit. Pre-test likelihood of CAD was based on clinical score + coronary artery calcium score (CACS). Significant CAD (>50% coronary stenosis) criteria were applied in all pts by computerized tomography coronary angiography (CTCA).

Results: Distribution of population for DSS and STD is shown in the table. 498 (72%) pts were classified as “No further test (NFT)”, 110 (15.9%) “Exercise test (ET)/Functional Imaging (FI)”, 84 (12.1%) “CTA” and 0 “(ICA)” by DSS. Of note, 483 (97%) of DSS “NFT” showed no significant CAD vs 576 (99%) of STD “CTA” (p=0.3). 110 (15.9%) pts were assigned by DSS to “ET/FI” as the first approach vs 27 (3.9%) of STD (p=0.0001). The remaining 38 of STD “ET/FI” performed the test after CTCA. The diagnostic accuracy was 97.8% by DSS in the “NFT” group.

Conclusions: DSS is a sensitive tool for applying good clinical practice in pts with a L-LI pre-test likelihood of CAD. For the “NFT” group DSS was demonstrated to be highly accurate to exclude CAD. It could be a promising tool to substantially improve health care quality avoiding unnecessary tests and reducing costs.

Table 1
Clinical Score + CAC (n/%)
Low (480 / 48.9)Low-to-intermediate (212 / 21.5)
CDSS (n/%)
  NFT (498 / 72)377 / 78.5121 / 57.0
  ET/FI (110 / 15.9)42 / 8.768 / 32.0
  CTA (84 / 12.1)61 / 12.823 / 11.0
  ICA (0 / 0)0 / 00 / 0
STD (n/%)
  NFT (45 / 6.5)39 / 8.16 / 2.8
  ET/FI (65 / 9.4)31 / 6.434 / 16.1
  CTA (582 / 84.1)410 / 85.5172 / 81.1
  ICA (0 / 0)0 / 00 / 0

The free consultation period for this content is over.

It is now only available year-round to ESC Professional Members, Fellows of the ESC, and Young combined Members



Based on your interests

Members get more

Join now
  • 1ESC Professional Members – access all resources from ESC Congress and ESC Asia with APSC & AFC
  • 2ESC Association Members (Ivory, Silver, Gold) – access your Association’s congress resources
  • 3Under 40 or in training - with a Combined Membership, access resources from all congresses
Join now

Our sponsors

ESC 365 is supported by Bayer, Boehringer Ingelheim and Lilly Alliance, Bristol-Myers Squibb and Pfizer Alliance, Novartis Pharma AG and Vifor Pharma in the form of educational grants. The sponsors were not involved in the development of this platform and had no influence on its content.

logo esc

Our mission: To reduce the burden of cardiovascular disease

Who we are