Temporal Trends in the Utilization of Diagnostic Testing and Treatments for Cardiovascular Disease in the United States, 1993–2001

Abstract

Background-Rates of invasive testing and treatment for coronary artery disease have increased over time. Less is known about trends in the utilization of noninvasive cardiac testing for coronary artery disease. The objective of this study was 2-fold: to explore temporal trends in the utilization of noninvasive and invasive cardiac services in relation to changes in the prevalence of cardiac disease, and to examine whether temporal increases have been targeted to potentially underserved populations. Methods and Results-We performed an annual cross-sectional population-based study of Medicare patients from 1993 to 2001. We identified stress testing, cardiac catheterization, and revascularization procedures, as well as hospitalizations for acute myocardial infarction, during each year and calculated population-based rates for each using the total fee-for-service Medicare population as the denominator and adjusting for age, gender, and race. We observed marked growth in the utilization rates of cardiac services over time, with relative rates nearly doubling for most services. Acute myocardial infarction hospitalization rates have remained stable over the study period. Although rates of all procedures except coronary artery bypass increased in all subgroups, differences in rates of cardiac testing and treatment between nonblack men and other subgroups persisted over time. Conclusions-Temporal increases in the use of noninvasive and invasive cardiac services are not explained by changes in disease prevalence and have not succeeded in narrowing preexisting treatment differences by gender and race. Such increases, although conferring benefit for some, may expose others to risk and cost without benefit. (Circulation. 2006; 113:374-379.)

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

“…In fact, in 2002, ≈9.3 million such tests were performed in the Unites States 6. 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.…”

Rising Rates of Cardiac Procedures in the United States and Canada

“…1,2 Each of these studies used claims data from its Medicare program to assess rates of acute myocardial infarction (AMI) and cardiac procedures through 2001 and to estimate the diagnostic "yield" of stress tests and cardiac catheterizations that led to subsequent procedures. The US study included all elderly adults receiving fee-forservice care in the US Medicare program, 1 and the Canadian study included adults of all ages residing in Ontario. 2 In both countries, increases in procedure rates over time were most pronounced for stress imaging studies, cardiac catheterizations, and coronary angioplasty, whereas rates of AMI as a marker of CHD prevalence were relatively constant.…”

Cancer Risk from Medical Radiation Procedures for Coronary Artery Disease: A Nationwide Population-based Cohort Study

“…The risks of leukemia and thyroid cancer were increased in the population under 30 years of age at exposure (Hwang et al, 2006). CAD is diagnosed by electrocardiography (ECG), echocardiography, myocardial perfusion scintigraphy (MPS), coronary angiography (CA), cardiac ventriculography (CV), computed tomographic coronary angiography (CTCA), and treated via percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass graft (CABG) (Lucas et al, 2006). The effective doses of MPS, CA, CV, CTCA and PTCA are relatively higher than those of other radiological procedures, about 7-40 mSv (Einstein et al, 2007a;Mettler et al, 2008).…”

“…The effective doses of MPS, CA, CV, CTCA and PTCA are relatively higher than those of other radiological procedures, about 7-40 mSv (Einstein et al, 2007a;Mettler et al, 2008). The increasing utilization of the above procedures may result in the increment of projected cancer risks (Lucas et al, 2006;Einstein et al, 2007b). Justification between the effectiveness obtained from medical radiation procedure and the risk of radiationinduced cancer is becoming an important issue.…”