Posted by John Ager on 24 September 2012.
Cardiac CT scans are an extremely effective diagnostic tool for detecting heart disease in patients presenting with symptoms of heart attack, like chest pain. Failure to diagnose heart attack is one of the leading medical malpractice claims in emergency medicine. That’s because heart attack symptoms are very non-specific, meaning they can indicate a variety of conditions which a physician might mistake for the cause of heart attack related symptoms. While many, many emergency department visits are for chest pain, 90% of the time the pain is the result of something other than a heart attack, like indigestion or musculoskeletal strain. But what about the other 10%?
Where some symptoms of heart attack are present, non-invasive tests are often not sensitive enough to rule it out. This is why we often see patients dying of heart attack shortly after being discharged from emergency departments with inaccurate diagnoses. Unlike less sensitive tests, cardiac CT can accurately diagnose whether symptoms are heart attack related in most of the patients who receive it, even when the symptoms are minor, potentially saving a life. Unfortunately, high amounts of radiation and other risks make cardiac CT a poor choice for patients who are not likely suffering from a cardiac event. As a result, the use of cardiac CT scans in patients who have minimal or no presenting symptoms is controversial given the risks involved. Of course, if the risk is death, it makes sense to me to err on the side of caution, even if it means an increased risk of radiation caused cancer many years in the future?
We often hear that medical malpractice lawsuits force health care providers to practice defensive medicine – performing more tests than necessary or appropriate, “just to be safe” – increasing the cost of health care. This argument has never made much sense to me since lawsuits like these are only brought when the failure to do a test would have made a difference. That means defensive medicine saves lives. Other than saving lives, however, cardiac CT actually actually lowers health care costs by allowing patients to be discharged sooner and with a high degree of confidence in the diagnosis. If you have non-specific chest pain, but “only” a 10% chance of heart attack, wouldn’t you want a defensive approach to your care, just to be safe? It no surprise that the use of cardiac CT is expected to rise considerably in the coming years.