Nuclear myocardial perfusion imaging (MPI) accounted for much of the rapid growth in cardiac imaging that occurred from the 1990s through the middle 2000s. Factors potentially discouraging use (including publication of appropriate use criteria) have since emerged, and recent data reveal modest declines in MPI use in the Medicare fee-for-service population.4
We investigated temporal trends in MPI use within a large, community-based population that included persons younger than 65 years and explored whether increasing use of other noninvasive imaging modalities potentially offset declining MPI use.
After increasing from 2000 to 2006, MPI use abruptly declined through 2011 within our population. Declines for persons aged 65 years or older exceeded those for the Medicare fee-for-service population during the same period and were even greater for younger persons. These declines could not be explained by increasing use of alternative modalities.
Although the abrupt nature of the decline suggests changing physician behavior played a major role, incident coronary disease, as assessed by MI, also declined. We could not determine the relative effects of these factors on MPI use.
Our findings should be interpreted in the context of other limitations. The observed decline occurred in the context of a health care delivery system without direct financial incentives to perform tests. Nevertheless, the substantial reduction in MPI use demonstrates the ability to reduce testing on a large scale with anticipated reductions in health care costs.