Evidence map›Paper›PMID 37403443›Full record

ArticleThe Medical journal of Australia2023

Clinical outcomes and health care costs of transferring rural Western Australians for invasive coronary angiography, and a cost-effective alternative care model: a retrospective cross-sectional study.

Mikhail Alexander, Nick S R Lan, Michael J Dallo, Tom G Briffa, Frank M Sanfilippo, Andrew Hooper, Helen Bartholomew, Loletta Hii, Graham S Hillis, Brendan M McQuillan and 3 more

Open access · hybridAbstract read
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In one paragraph

Article in The Medical journal of Australia, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
2.8field-weighted citation impact, top 10% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 12 citations in OpenAlex.

  1. Article
  2. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

13 authors at 3 institutions in 1 country.

Mikhail AlexanderFiona Stanley Hospital, Perth, WA.
Nick S R LanFiona Stanley Hospital, Perth, WA.ORCID 0000-0002-7222-7314
Michael J DalloFiona Stanley Hospital, Perth, WA.
Tom G BriffaThe University of Western Australia, Perth, WA.
Frank M SanfilippoThe University of Western Australia, Perth, WA.ORCID 0000-0003-3639-0787
Andrew HooperMedical Royal Flying Doctor Service Western Australia, Perth, WA.
Helen BartholomewMedical Royal Flying Doctor Service Western Australia, Perth, WA.ORCID 0000-0002-6128-1606
Loletta HiiFiona Stanley Hospital, Perth, WA.
Graham S HillisRoyal Perth Hospital, Perth, WA.
Brendan M McQuillanThe University of Western Australia, Perth, WA.
Girish DwivediFiona Stanley Hospital, Perth, WA.
James M RankinFiona Stanley Hospital, Perth, WA.
Abdul Rahman IhdayhidFiona Stanley Hospital, Perth, WA.
The University of Western Australia · AURoyal Perth Hospital · AUHarry Perkins Institute of Medical Research · AU

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesTo examine the severity of coronary artery disease (CAD) in people from rural or remote Western Australia referred for invasive coronary angiography (ICA) in Perth and their subsequent management; to estimate the cost savings were computed tomography coronary angiography (CTCA) offered in rural centres as a first line investigation for people with suspected CAD.

designRetrospective cohort study. SETTING,

participantsAdults with stable symptoms in rural and remote WA referred to Perth public tertiary hospitals for ICA evaluation during the 2019 calendar year.

main outcome measuresSeverity and management of CAD (medical management or revascularisation); health care costs by care model (standard care or a proposed alternative model with local CTCA assessment).

resultsThe mean age of the 1017 people from rural and remote WA who underwent ICA in Perth was 62 years (standard deviation, 13 years); 680 were men (66.9%), 245 were Indigenous people (24.1%). Indications for referral were non-ST elevation myocardial infarction (438, 43.1%), chest pain with normal troponin level (394, 38.7%), and other (185, 18.2%). After ICA assessment, 619 people were medically managed (60.9%) and 398 underwent revascularisation (39.1%). None of the 365 patients (35.9%) without obstructed coronaries (< 50% stenosis) underwent revascularisation; nine patients with moderate CAD (50-69% stenosis; 7%) and 389 with severe CAD (≥ 70% stenosis or occluded vessel; 75.5%) underwent revascularisation. Were CTCA used locally to determine the need for referral, 527 referrals could have been averted (53%), the ICA:revascularisation ratio would have improved from 2.6 to 1.6, and 1757 metropolitan hospital bed-days (43% reduction) and $7.3 million in health care costs (36% reduction) would have been saved.

conclusionMany rural and remote Western Australians transferred for ICA in Perth have non-obstructive CAD and are medically managed. Providing CTCA as a first line investigation in rural centres could avert half of these transfers and be a cost-effective strategy for risk stratification of people with suspected CAD.

Indexed as

Coronary Artery DiseaseDelivery of Health CareHealth Care CostsAgedAustralasian PeopleAustraliaAustralian Aboriginal and Torres Strait Islander PeoplesComputed Tomography AngiographyConstriction, PathologicCoronary AngiographyCost-Benefit AnalysisCross-Sectional StudiesFemaleHumansMaleMiddle AgedCardiac imaging techniquesComputed tomographyCoronary artery diseaseRural health services

Identifiers

PMID37403443
OpenAlexW4383186269

What OpenQuestion holds

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.