Providing medical assistance for a cardiac patient in Thailand

The patient had no prior heart issues and had never reported chest pain. Despite this, the local cardiology team suggested expensive and invasive procedures, including a guidewire coronary angiogram and stenting, and a cardiac MRI scan.

However, with no history of chest pain and normal blood troponin levels (indicating no signs of a heart attack) there was no evidence of a new acute cardiac event.

A CT coronary angiogram was recommended

Our in-house medical team, which includes the specialist knowledge of a cardiologist, carefully assessed the circumstances and documentation, requesting additional observations and communicating with the local medical team to assist in reaching an informed decision, ultimately recommending a quick and noninvasive CT coronary angiogram as the first-line approach.

This method is the preferred, least invasive, and clinically accepted procedure for detecting potential coronary artery blockages, especially in stable patients.

Despite initial resistance from the local team – who were concerned about the potential risks of contrast dye used in the CT angiogram scan – our medical team clarified that the same contrast dye is used in invasive angiograms which they had initially proposed, dispelling their concerns.

Following our guidance, the local team proceeded with the CT angiogram, which, as suspected, revealed no coronary artery obstructions, effectively ruling out the need for the invasive procedures originally proposed.

Cost-savings and fewer complications

By guiding the case toward a more efficient, cost-effective solution, Mayday not only saved unnecessary costs for the insurer, but also protected the patient from potential complications associated with invasive procedures.

This case highlights the importance of providing evidence-based, patient-centred care that aligns with ‘best practices’ along with insurance company interests, ensuring the best outcomes for patients while minimising unnecessary costs.

It highlights a benchmark practice along the lines of proactive ‘cost avoidance’ through more forensic and appropriate medical care, as opposed to the ‘cost containment’ model of simply reviewing invoices post-hoc, to attempt to mitigate expenditure after procedures have already been carried out.