ACCF/ASNC/ACR/AHA/ASE/SCCT/SCMR/SNM 2009 Appropriate Use Criteria for Cardiac Radionuclide Imaging

Hendel, Robert C.; Berman, Daniel S.; Carli, Marcelo F. Di; Heidenreich, Paul A.; Henkin, Robert E.; Pellikka, Patricia A.; Pohost, Gerald M.; Williams, Kim A.

doi:10.1016/j.jacc.2009.02.013

Cited by 528 publications

(129 citation statements)

References 22 publications

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“…Concern about the potential overutilization of noninvasive cardiac imaging has led to the development of health policy initiatives such as appropriate use criteria (AUC) publications geared to curb utilization 7, 8, 9, 10, 11. AUC have been published on MPI exclusively on 2 occasions (2005 and 2009) and as part of a multimodality AUC publication in 2014 12, 13, 14. Despite the multiple iterations of the AUC, the impact of these publications on physician behavior as reflected by population‐based rates of MPI utilization is unknown.…”

Section: Introductionmentioning

confidence: 99%

Impact of the Publication of Appropriate Use Criteria on Utilization Rates of Myocardial Perfusion Imaging Studies in Ontario, Canada: A Population‐Based Study

Roifman

Austin

Qiu

et al. 2017

JAHA

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BackgroundConcern regarding overutilization of cardiac imaging has led to the development of appropriate use criteria (AUC). Myocardial perfusion imaging (MPI) is one of the most commonly used cardiac imaging modalities worldwide. Despite multiple iterations of AUC, there is currently no evidence regarding their real‐world impact on population‐based utilization rates of MPI. Our goal was to assess the impact of the AUC on rates of MPI in Ontario, Canada. We hypothesized that publication of the AUC would be associated with a significant reduction in MPI rates.Methods and ResultsWe conducted a retrospective cohort study of the adult population of Ontario from January 1, 2000, to December 31, 2015. Age‐ and sex‐standardized rates were compared from 4 different periods intersected by 3 published iterations of the AUC. Overall, 3 072 611 MPI scans were performed in Ontario during our study period. The mean monthly rate increased from 14.1/10 000 in the period from January 2000 to October 2005 to 18.2/10 000 between November 2005 and June 2009. After this point in time, there was a reduction in rates, falling to a mean monthly rate of 17.1/10 000 between March 2014 and December 2015. Time series analysis revealed that publication of the 2009 AUC was associated with a significant reduction in MPI rates (P<0.001). This translated into ≈88 849 fewer MPI scans at a cost savings of ≈72 million Canadian dollars.ConclusionsOur results reflect a potential real‐world impact of the 2009 MPI AUC by demonstrating evidence of a significant effect on population‐based rates of MPI.

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Section: Introductionmentioning

confidence: 99%

Impact of the Publication of Appropriate Use Criteria on Utilization Rates of Myocardial Perfusion Imaging Studies in Ontario, Canada: A Population‐Based Study

Roifman

Austin

Qiu

et al. 2017

JAHA

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“…De acuerdo al estudio DIAD en DM asintomáticos cardíacos, el uso de estudios con provocación de isquemia no se aconseja entre otras causas por la baja capacidad de detección de la prueba, número de eventos relativamente bajo que no parecen afectar la evolución y además su alto costo. Por ello, las recomendaciones actuales para estudios de provocación en DM asintomáticos CV, desaconsejan su uso rutinario 18 . Sin embargo, la población en que fue efectuado el estudio DIAD, el pronóstico era favorable con seguimiento estrecho, terapia adecuada y evaluación de aparición de síntomas isquémicos.…”

Section: Materials Y Métodosunclassified

Seguimiento a Cinco Años en Pacientes Diabéticos Sin Síntomas Cardíacos Estudiados Con Perfusión Miocárdica

et al. 2013

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5 años, >45 años de edad, con >2 factores de riesgo cardiovascular (FRCV) y electrocardiograma basal normal o con alteraciones inespecíficas. Todos efectuaron una prueba de esfuerzo (PE) adecuada y se estudiaron con Sestamibi-Tc99m repetido en 32 casos al 3° año. Además, se evaluó a 36 controles no diabéticos con >2 FRCV. El seguimiento fue de 64±11 meses. Resultados: En el grupo DM, 48% tenía Hba1c>7.5%; en ellos el SPECT mostró isquemia silente (IS) en 30% y la PE en 18% del total. No hubo variaciones significativas en SPECT al 3° año. Hubo una muerte no cardíaca en el 2° año; en el 4° año, se produjo una muerte por infarto agudo de miocardio, con mínima isquemia septal y otra asociada a miocardiopatía e insuficiencia cardíaca, con defecto de predominio fijo, ambos con PE negativa. En el grupo control, el 11% tuvo SPECT anormal y 8% PE positiva; hubo una muerte no cardíaca. El Odds Ratio para isquemia fue 3.42 [IC=0.99-11.85] entre DM vs controles y el Hazard Ratio para eventos cardíacos 6.75 [IC=0.40-108.2]. Conclusiones: En DM asintomáticos coronarios el riesgo de IS en SPECT fue mayor que en controles sin DM y con FRCV. Los eventos cardiacos mayores fueron más frecuentes, aunque no significativamente, en DM que en controles. Ello deberá reevaluarse conocidos los resultados del estudio multicéntrico.]]>

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“…8 During these five decades, the population has become more aware of the importance of risk factors, and the medicine and technology have evolved. As a result, the incidence of death from cardiovascular disease has decreased, 9 the incidence of ischemia on myocardial perfusion scans has decreased, 10 and the frequency of performing myocardial perfusion scans has decreased 11 with the introduction of appropriate use criteria, 12 and widespread use of competing technologies including 3-D transthoracic echocardiography, 13 delayed contrast enhancement upon magnetic resonance imaging to detect areas of myocardial necrosis, 14,15 CT coronary angiography for plaque characterization, 16 and fractional (FFR) or coronary flow reserve (CFR). 17 At this moment, it is unlikely that there will be another single 'killer app' for molecular nuclear cardiology.…”

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confidence: 99%

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Strausś

Narula

2016

Journal of Nuclear Cardiology

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ACCF/ASNC/ACR/AHA/ASE/SCCT/SCMR/SNM 2009 Appropriate Use Criteria for Cardiac Radionuclide Imaging

Cited by 528 publications

References 22 publications

Impact of the Publication of Appropriate Use Criteria on Utilization Rates of Myocardial Perfusion Imaging Studies in Ontario, Canada: A Population‐Based Study

Impact of the Publication of Appropriate Use Criteria on Utilization Rates of Myocardial Perfusion Imaging Studies in Ontario, Canada: A Population‐Based Study

Seguimiento a Cinco Años en Pacientes Diabéticos Sin Síntomas Cardíacos Estudiados Con Perfusión Miocárdica

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