Cardiologists at Wellspan York (Pa.) Hospital are working to change the standard of care for patients with heart complaints thanks to a new 4D cardiac CT scan machine.
Currently, patients who experience symptoms of heart disease typically have at least three points of contact with the health system, Stewart Benton, MD, director of the cardiac catheterization lab at WellSpan York Hospital, said. Diagnosis and treatment can take an average of two to four weeks if everything goes well, and longer if insurance preauthorization issues arise or there are delays getting appointments.
"It starts when a patient has a complaint of chest discomfort, shortness of breath, something like that. Typically, they see their primary care provider or come into the emergency department. That's when a referral is made to a cardiologist. That's the first touchpoint and the first delay in treatment," Dr. Benton said. "From there patients are referred for a noninvasive stress test. That's the second touchpoint where there's a delay: You see the cardiologist, they refer you for a stress test and the patient waits to do the test then waits again to get the results. Then there's the third touchpoint where patients go in for an invasive study in the cath lab. That's the point where the diagnosis of coronary disease would be confirmed. If the disease is amenable to PCI or stenting, it would be treated at that time."
But with the new CT scan machine, Dr. Benton has diagnosed and treated some patients in as little as five hours.
Recently, he had a virtual office visit with a patient concerning intermediate risk chest pain. He asked the patient to come to the hospital the next day to undergo a 4D CT scan. The single scan showed one artery was critically blocked. "That scan allowed me to quickly convert from the diagnostic procedure to the therapeutic one," Dr. Benton said. He proceeded with a stent treatment and after a four-hour observation, the patient went home. The entire process took around five hours and in a single room.
The cardiac CT scans are helpful for more than just diagnosis. They can help with preclinical disease that would not be caught in a traditional stress test.
"It's kind of akin to a mammogram for breast cancer or a screening for colonoscopy. You catch the disease before it's clinically apparent," Dr. Benton said. "As things are now, we can tell patients, 'Your stress test was normal because the disease may be preclinical.' The patient hears that and they're less motivated to change their lifestyle. But that disease will continue untreated until one day they may come in with a heart attack. At that point it's too late.
"But with these scans we can say, 'The atherosclerosis is worse and you're at higher risk of a heart attack. This is an important window to change your future outcomes.' We can start lowering blood pressure and cholesterol and talk about diet and lifestyle to modify that disease so the patient doesn't have to suffer a heart attack to find out they had it."
The traditional pathway is inefficient, he said.
"During the pandemic we had to maximize efficiency and rethink how we provide treatment to patients," Dr. Benton said. "We had to ask, 'How can we scale this path of treatment with CT scans? How could this be operationalized?' We could start changing the paradigm of what standard care might be."
He said it starts with doing what is best for patients and designing a care pathway that meets that goal.
"A hospital could place two or three of these suites in an emergency department and service all chest pain syndromes that come through," Dr. Benton said. "You could have a point of care where patients are diagnosed and treated, then discharge to close outpatient follow-up. It could be the new standard in heart care."