Application of appropriate use criteria for stress myocardial perfusion imaging at two academic medical centers: Compliance and association with image findings

Soine, Laurie A.; Cunningham, Shayna D.; Motzer, Sandra Adams; Inoue, Lurdes Y.T.; Caldwell, James H.

doi:10.1111/j.1745-7599.2011.00679.x

Cited by 4 publications

(3 citation statements)

References 35 publications

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“…10–20,34–44 The results of our search strategy are illustrated in Figure 1. The 2005 AUC were used by 6 studies, 16,18,19,39,42,44 and the remainder used the 2009 AUC. 10–15,17,20,34–38,40,41,43 Single-photon emission computed tomography (SPECT) was the modality utilized in most of the studies, 13–20,34–36,38,39,41–44 one study reported using positron emission tomography (PET), 12 while the remainder of the studies did not specify.…”

Section: Resultsmentioning

confidence: 99%

Outcomes after inappropriate nuclear myocardial perfusion imaging: A meta-analysis

Elgendy

Mahmoud

Shuster

et al. 2016

Journal of Nuclear Cardiology

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Background The relationship between inappropriate MPI and cardiovascular outcomes is poorly understood. We sought to systematically review the literature on appropriate use criteria (AUC) for MPI, including temporal trend of inappropriate testing and resulting cardiovascular outcomes. Methods We searched the MEDLINE database for studies related to AUC and MPI. The co-primary outcomes were abnormal test results and the presence of cardiac ischemia. Random effects odds ratios (OR) were constructed using DerSimonian-Laird method. Results A total of 22 studies with 23,443 patients were included. The prevalence of inappropriate testing was 14.8 % [95% confidence interval (CI) 11.6–18.7%]. Inappropriate MPI studies were less likely to be abnormal (OR 0.41 95% CI 0.35–0.49, p<0.0001) and to demonstrate ischemia (OR 0.40, 95% CI 0.24–0.67, p<0.0001) compared to appropriate testing. No difference in the rate of inappropriate tests was detected based on the midpoint of the enrollment year (p=0.54). The pattern of ordering inappropriate studies was not different between cardiology and non-cardiology providers (OR 0.74, 95% CI 0.51–1.06, p=0.10). Conclusion Inappropriate MPI studies are less likely to yield abnormal results or demonstrate myocardial ischemia. The rate of inappropriate MPI has not decreased over time.

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Section: Resultsmentioning

confidence: 99%

Outcomes after inappropriate nuclear myocardial perfusion imaging: A meta-analysis

Elgendy

Mahmoud

Shuster

et al. 2016

Journal of Nuclear Cardiology

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“…Of the remaining 122 citations, 34 met inclusion criteria and were selected for full-text review and data extraction. These articles included 6 articles and 6 cohorts for the stress echocardiography 2008 AUC,[ 11 , 13 – 17 ] 6 articles and 8 cohorts for the stress echocardiography 2011 AUC,[ 13 , 17 – 21 ] 10 articles and 11 cohorts for the stress MPI 2005 AUC,[ 22 – 31 ] and 18 articles and 21 cohorts for the stress MPI 2009 AUC. [ 14 , 20 , 23 , 30 , 32 – 45 ] Some studies contributed multiple cohorts to our meta-analysis.…”

Section: Resultsmentioning

confidence: 99%

“…[ 17 ] Similarly, for stress MPI 2005 AUC, Soine et al contributed two cohorts (one cohort underwent testing at University of Washington Medical Center and the second cohort underwent testing at the Veterans Health Administration of Puget Sound). [ 31 ] Each cohort is separately presented in the figures (note that enrollment dates are rounded to the nearest year).…”

Section: Resultsmentioning

confidence: 99%

Appropriate Use of Cardiac Stress Testing with Imaging: A Systematic Review and Meta-Analysis

et al. 2016

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BackgroundAppropriate use criteria (AUC) for cardiac stress tests address concerns about utilization growth and patient safety. We systematically reviewed studies of appropriateness, including within physician specialties; evaluated trends over time and in response to AUC updates; and characterized leading indications for inappropriate/rarely appropriate testing.MethodsWe searched PubMed (2005–2015) for English-language articles reporting stress echocardiography or myocardial perfusion imaging (MPI) appropriateness. Data were pooled using random-effects meta-analysis and meta-regression.ResultsThirty-four publications of 41,578 patients were included, primarily from academic centers. Stress echocardiography appropriate testing rates were 53.0% (95% CI, 45.3%–60.7%) and 50.9% (42.6%–59.2%) and inappropriate/rarely appropriate rates were 19.1% (11.4%–26.8%) and 28.4% (23.9%–32.8%) using 2008 and 2011 AUC, respectively. Stress MPI appropriate testing rates were 71.1% (64.5%–77.7%) and 72.0% (67.6%–76.3%) and inappropriate/rarely appropriate rates were 10.7% (7.2%–14.2%) and 15.7% (12.4%–19.1%) using 2005 and 2009 AUC, respectively. There was no significant temporal trend toward rising rates of appropriateness for stress echocardiography or MPI. Unclassified stress echocardiograms fell by 79% (p = 0.04) with updated AUC. There were no differences between cardiac specialists and internists.ConclusionsRates of appropriate use tend to be lower for stress echocardiography compared to MPI, and updated AUC reduced unclassified stress echocardiograms. There is no conclusive evidence that AUC improved appropriate use over time. Further research is needed to determine if integration of appropriateness guidelines in academic and community settings is an effective approach to optimizing inappropriate/rarely appropriate use of stress testing and its associated costs and patient harms.

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Long-Term Prognostic Value of Appropriate Myocardial Perfusion Imaging

Koh

Lye

Chia

et al. 2017

The American Journal of Cardiology

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Application of appropriate use criteria for stress myocardial perfusion imaging at two academic medical centers: Compliance and association with image findings

Cited by 4 publications

References 35 publications

Outcomes after inappropriate nuclear myocardial perfusion imaging: A meta-analysis

Outcomes after inappropriate nuclear myocardial perfusion imaging: A meta-analysis

Appropriate Use of Cardiac Stress Testing with Imaging: A Systematic Review and Meta-Analysis

Long-Term Prognostic Value of Appropriate Myocardial Perfusion Imaging

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