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CV testing practices for incident HF vary widely across hospitals
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Substantial disparities exist in the prevalence of CV testing prevalence across hospitals among patients hospitalized for HF, particularly in terms of CAD testing modalities, according to recent findings.
Researchers evaluated 5,878 participants aged at least 21 years who were enrolled in the Cardiovascular Research Network HF study, sponsored by the NHLBI. All patients were hospitalized for incident HF between 2005 and 2008 at facilities within the Kaiser Permanente Northern California, Kaiser Permanente Colorado and Kaiser Permanente Northwest regions.
The researchers chronicled all CV testing that occurred 14 days before to 180 days after incident HF hospitalization according to administrative records, imaging reports and manual review of patient medical records. Procedures defined as CV testing included the following: transthoracic, transesophageal or stress echocardiography, single-photon emission CT, PET, cardiac MRI, nuclear scintigraphy, left ventriculography, left heart catheterization, right and left heart catheterization and cardiac CTA.
Among the evaluated patients, CV testing was performed in 4,650 cases during the study period. Of these, 87.9% underwent echocardiogram, 93.4% underwent systolic function assessment and 36.9% underwent CAD evaluation, with 26.1% of participants undergoing multiple tests.
Researchers observed wide variation in both crude and adjusted testing rates across participating hospitals. Overall, adjusted odds for use of any CV testing ranged from 0.44 (95% CI, 0.36-0.54) to 1.2 (95% CI, 0.92-1.55).
Systolic function assessment occurred at adjusted rates ranging from 53.9 cases to 242.7 per 100 patient-years, with adjusted HR for testing ranging from 0.69 (95% CI, 0.62-0.77) to 1.29 (95% CI, 0.97-1.72). Ischemia assessment occurred at rates ranging from 31.1 cases to 140.5 per 100 patient-years, with adjusted HR ranging from 0.76 (95% CI, 0.53-1.1) to 1.98 (95% CI, 1.47-2.65). Echocardiogram testing rates ranged from 22.3 to 161.8 per 100 patient-years; stress echocardiogram testing rates ranged from 3.5 to 37.2 per 100 patient-years; SPECT testing rates ranged from 1.3 to 63.9 per 100 patient-years; and left heart catheterization testing rates ranged from 9.3 to 63.4 per 100 patient-years.
“In a contemporary population of adults hospitalized for incident HF, we found significant hospital-level variations in CV testing that did not appear to be explained by patient case mix,” the researchers wrote. “The greatest variations occurred in testing modalities for CAD, in which less rigorous evidence exists for their clinical utility. More research is needed to clarify the most cost-effective test or testing combination for patients with incident HF.”
Disclosure: The researchers report no relevant financial disclosures.
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