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Advanced cardiac imaging techniques in the management of acute chest pain and related health services delivery

Kolling Institute

Grant:
  • Early-Mid Career Fellowship
Organ System:
  • Cardiovascular
Date Funded:
  • 31 May, 2018
Chief Investigator/s:
  • Dr. Rebecca Kozor

Chest pain is one of the most common presentations to adult emergency departments. Its management requires specialist assessment and tests, which places a significant burden on hospital resources and patients. To address this, Royal North Shore Hospital has implemented a rapid access Chest Pain Clinic (CPC) – a new model of care, for which I am director. As part of this, there is the need for cardiac investigations that are feasible, diagnostic, and cost-effective. Two advanced cardiac diagnostic techniques have untapped potential in this setting in Australia – cardiovascular magnetic resonance (CMR) and advanced electrocardiography (A-ECG). This fellowship seeks to develop new insights into health service of acute chest pain by the application and development of these state-of-the-art investigations to create a paradigm shift in chest pain management and improve healthcare costs.

CMR is the future of non-invasive cardiology, and is utilised widely in clinical practice and research worldwide but less so in Australia because of slow adoption and restrictions with Medicare rebate. In European and UK healthcare models, CMR with stress testing (‘stress CMR’) has been shown to be cost-effective in the management of suspected coronary disease with high diagnostic and prognostic performance. There is a lack of evidence of stress CMR in the Australian healthcare setting. Part 1 of this study will assess the cost-effectiveness of stress CMR in the CPC, in order to optimise its use in Australia.

The traditional ECG is a fundamental cardiac test. Standard analysis depends on visual assessment. Novel methods for computerised ECG measurement permit the application of advanced digital analysis techniques collectively known as A-ECG, which have dramatically higher diagnostic accuracy for detecting disease. Currently, A-ECG is only available in a handful of international centres outside Australia. Part 2 of this study will assess A-ECG in the CPC to show its diagnostic performance, ability to influence downstream tests, and power to predict cardiovascular outcomes. A-ECG could be the much needed paradigm shift in chest pain management – to allow patients to be managed safely as outpatients, thus avoiding hospital admission and unnecessary tests, and improving healthcare costs.

The overarching goals are aligned with Sydney Health Partners’ Cardiovascular Stream and the Northern Sydney Local Health District. Collaboration with international centres of excellence will support the science and the technology. Translation of findings and implementation into clinical practice will be led by the research team, which includes engagement with key stakeholders and hospital administration.

Chest pain is one of the most common presentations to adult emergency departments. Its management requires specialist assessment and tests, which places a significant burden on hospital resources and patients. To address this, Royal North Shore Hospital has implemented a rapid access Chest Pain Clinic (CPC) – a new model of care, for which I am director. As part of this, there is the need for cardiac investigations that are feasible, diagnostic, and cost-effective. Two advanced cardiac diagnostic techniques have untapped potential in this setting in Australia – cardiovascular magnetic resonance (CMR) and advanced electrocardiography (A-ECG). This fellowship seeks to develop new insights into health service of acute chest pain by the application and development of these state-of-the-art investigations to create a paradigm shift in chest pain management and improve healthcare costs.

CMR is the future of non-invasive cardiology, and is utilised widely in clinical practice and research worldwide but less so in Australia because of slow adoption and restrictions with Medicare rebate. In European and UK healthcare models, CMR with stress testing (‘stress CMR’) has been shown to be cost-effective in the management of suspected coronary disease with high diagnostic and prognostic performance. There is a lack of evidence of stress CMR in the Australian healthcare setting. Part 1 of this study will assess the cost-effectiveness of stress CMR in the CPC, in order to optimise its use in Australia.

The traditional ECG is a fundamental cardiac test. Standard analysis depends on visual assessment. Novel methods for computerised ECG measurement permit the application of advanced digital analysis techniques collectively known as A-ECG, which have dramatically higher diagnostic accuracy for detecting disease. Currently, A-ECG is only available in a handful of international centres outside Australia. Part 2 of this study will assess A-ECG in the CPC to show its diagnostic performance, ability to influence downstream tests, and power to predict cardiovascular outcomes. A-ECG could be the much needed paradigm shift in chest pain management – to allow patients to be managed safely as outpatients, thus avoiding hospital admission and unnecessary tests, and improving healthcare costs.

The overarching goals are aligned with Sydney Health Partners’ Cardiovascular Stream and the Northern Sydney Local Health District. Collaboration with international centres of excellence will support the science and the technology. Translation of findings and implementation into clinical practice will be led by the research team, which includes engagement with key stakeholders and hospital administration.