Aggregate values, not arithmetic

Brenna, Connor T. A.; Afgani, Fahmeen J.; Hanneman, Kate; Nguyen, Elsie T.

doi:10.46747/cfp.6708562

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“…3 A variety of non-invasive testing modalities are available to investigate chest pain associated with CAD and assess the degree of coronary artery obstruction that leads to ischemia and chest pain or equivalent symptoms, including stress electrocardiography (GXT), stress echocardiography (SE), and myocardial perfusion scintigraphy (myocardial perfusion imaging/MPI). [4][5][6][7] When used in conjunction with clinical assessment, these tests aid in evaluating patients' risk of CAD and help to direct appropriate management. Unfortunately, they also frequently yield equivocal or inconclusive results, necessitating additional downstream testing and resulting in delayed diagnosis.…”

Section: Introductionmentioning

confidence: 99%

Cardiac Investigation Trends Among Primary Care Physicians: A Paradigm Shift

Afgani

Brenna

et al. 2022

Can Assoc Radiol J

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Objective While numerous recent guidelines support coronary computed tomography angiography (CTA) as a first-line test for stable chest pain, it remains underutilized by primary care physicians (PCPs). We aimed to evaluate cardiac investigation ordering practices following education sessions, as well as the total number of downstream tests and time to diagnosis for patients presenting with stable chest pain. Methods A retrospective chart review was completed for eligible patients assessed at the Women's College Hospital Family Practice Health Centre between 2017 and 2019 following the education sessions. The outcome measures were first-choice cardiac investigation, additional downstream testing, time from presentation to first investigation, and time to final diagnosis. Results 419 patients were included in the final analysis (74.70% female; mean age 61 ± 11 years). Coronary CTA requests by PCPs increased between 2017 and 2019 (18 vs 72 tests; P < .0001). When coronary CTA was the first-line test, patients were less likely to receive additional downstream testing when compared to those receiving other first-line investigations ( P < .0001). Coronary CTA was associated with longer time to diagnosis than stress echocardiography (47 ± 45 vs 27 ± 36 days; P = .0068) due to limited availability of coronary CTA appointment times. There was no significant difference in time to final diagnosis among the cardiac imaging modalities observed in the cohort ( P = .0623). Conclusion Utilization of coronary CTA as the first-line test for stable chest pain increased following our education sessions targeting PCPs. Coronary CTA was associated with less downstream testing compared to other non-invasive cardiac investigations.

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