Temporal Changes in Appropriateness of Cardiac Imaging

OBJECTIVES:  Appropriate use criteria (AUC) for cardiac imaging have been available for almost 10 years. The extent to which there has been a reported improvement in appropriate use is undefined. This study systematically reviewed published evidence to identify whether the promulgation of AUC has led to an improvement in the proportion of appropriate cardiac imaging requests.

METHODS:  Electronic databases were systematically searched for English-language papers related to AUC and cardiovascular imaging. We found 59 reports involving 103,567 tests that were published from 2000 to 2012. The rate of appropriate testing over time was analyzed in a meta-regression.

RESULTS:  New AUC were associated with apparent improvements in appropriateness for transthoracic echocardiography (TTE) (80% [95% confidence interval (CI): 0.75 to 0.84] vs. 85% [95% CI: 0.81 to 0.89]), transesophageal echocardiography (TEE) (89% [95% CI: 0.81 to 0.94] vs. 95% [95% CI: 0.93 to 0.96]) and computed tomography angiography (CTA) (37% [95% CI: 0.21 to 0.55] vs. 55% [95% CI: 0.44 to 0.65]) but not stress echocardiography (53% [95% CI: 0.45 to 0.61] vs. 52% [95% CI: 0.42 to 0.61]) or single-photon emission computed tomography (72% [95% CI: 0.66 to 0.77] vs. 68% [95% CI: 0.60 to 0.74]). Although there were no correlations between the proportion of appropriate TTEs and published year (p = 0.36) for 2007 AUC, there was a positive correlation between proportion of appropriateness and the year of publication (p = 0.01) for 2011 AUC. There was a significant decrease in the proportion of appropriateness over time using the 2007 TEE AUC (p = 0.03) and 2006 CT AUC (p = 0.02). There were no meaningful associations between appropriateness and publication year for stress echocardiography, CTA, or single-photon emission computed tomography.

CONCLUSIONS:  Rates of reported appropriate use in imaging show improvements for TTE and CTA but not for stress imaging and TEE. The observed reductions in imaging studies are not matched by reported rates of appropriate use. 


Posted in Computed Tomography, Echo, Magnetic Resonance Imaging, Nuclear Imaging and tagged , , .

One Comment


    COMPETENCY IN SYSTEMS-BASED PRACTICE: Appropriate use of echocardiography (TTE and TEE) ranges from 80% to 90%, whereas adherence to current AUC for noninvasive assessment of coronary disease ranges from 50% for stress echocardiography and CTA to ∼70% for radionuclide (SPECT) imaging. Over a 5-year period, there was improvement in appropriate use of TTE, TEE, and CTA, but no change in the proportion of appropriate use of the other modalities.

    TRANSLATIONAL OUTLOOK: The apparent discordance between AUC and clinical practice patterns suggests that more objective methods are needed to assess the appropriateness of diagnostic imaging procedures.

    The First Decade of Appropriate Use Criteria: Is the Glass Half Empty or Half Full?
    Todd D. Miller, J. Wells Askew.

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