Staged testing as a solution to the challenges of testing lower risk patients

Murthy, Venkatesh L.; Nasir, Khurram

doi:10.1007/s12350-018-1437-y

Journal of Nuclear Cardiology

2020

DOI: 10.1007/s12350-018-1437-y

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Staged testing as a solution to the challenges of testing lower risk patients

Venkatesh L. Murthy

Khurram Nasir

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Cited by 2 publications

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“…FIB‐4 has been suggested as a prescreening strategy to improve the efficiency of referral for specialized liver care, prioritizing patients who are at higher risk of significant liver disease. This type of staged testing has been recommended in other areas where the pretest probability is low, such as ischemia detection in low‐risk patients with coronary artery disease and screening for colorectal cancer in low‐risk individuals…”

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confidence: 99%

Impact of Implementing a “FIB‐4 First” Strategy on a Pathway for Patients With NAFLD Referred From Primary Care

et al. 2019

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Detection of advanced fibrosis in nonalcoholic fatty liver disease (NAFLD) is essential for stratifying patients according to the risk of liver‐related morbidity. Noninvasive methods such as vibration‐controlled transient elastography (VCTE) and Fibrosis‐4 index (FIB‐4) have been recommended to identify patients for further assessment. The aim of this study was to assess the potential impact of implementing a “FIB‐4 First” strategy to triage patients entering a NAFLD assessment pathway. The pathway for patients with suspected NAFLD was piloted at a tertiary liver center. Referral criteria were 16‐65 years old, elevated alanine aminotransferase and/or steatosis on imaging, and absence of a previous liver diagnosis. A registered nurse risk‐stratified all patients based on VCTE and FIB‐4 was calculated. Potential alternative diagnoses were excluded with bloodwork. A total of 565 patients underwent risk stratification with VCTE with a 97% success rate. Ten percent had VCTE of at least 8 kPa; 560 patients had FIB‐4 available for analysis and 87% had values less than 1.3. Of those with a FIB‐4 of at least 1.3, 69% had a VCTE less than 8 kPa. Further modeling showed that the presence of diabetes, age, and body mass index had only a moderate impact on the association between FIB‐4 and elastography values if using a FIB‐4 threshold of 1.3. Conclusion: A FIB‐4 threshold of 1.3 was acceptable for excluding the presence of advanced fibrosis (assessed by VCTE). A staged risk‐stratification model using FIB‐4 and VCTE could save up to 87% of further assessments. This model could improve accessibility by moving the initial fibrosis evaluation to the medical home and helping to prioritize patients for further specialized care.

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confidence: 99%

Impact of Implementing a “FIB‐4 First” Strategy on a Pathway for Patients With NAFLD Referred From Primary Care

et al. 2019

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Clinical Risk Scores to Minimize Low Yield Coronary Artery Disease Testing

Masri

Murthy

2019

Circ: Cardiovascular Imaging

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Staged testing as a solution to the challenges of testing lower risk patients

Cited by 2 publications

References 27 publications

Impact of Implementing a “FIB‐4 First” Strategy on a Pathway for Patients With NAFLD Referred From Primary Care

Impact of Implementing a “FIB‐4 First” Strategy on a Pathway for Patients With NAFLD Referred From Primary Care

Clinical Risk Scores to Minimize Low Yield Coronary Artery Disease Testing

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