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Study identifies temporal changes in appropriateness of CV imaging
Rates of reported appropriate use in cardiac imaging show improvement for some modalities but not others, and those rates do not match observed reductions in imaging studies, raising questions about the impact of appropriate use criteria, according to a recent report.
Appropriate use criteria for CV imaging have existed for approximately 10 years. Researchers investigated whether their promulgation has led to an improvement in the rate of appropriate CV imaging requests over time.
The analysis included 59 reports involving 103,567 tests published from 2000 to 2012. The researchers performed a meta-regression analysis to determine the rate of appropriate testing over time.
According to the results, new appropriate use criteria were associated with apparent improvements in appropriateness for transthoracic echocardiography (80%; 95% CI, 0.75-0.84 vs. 85%; 95% CI, 0.81-0.89), transesophageal echocardiography (89%; 95% CI, 0.81-0.94 vs. 95%; 95% CI, 0.93-0.96) and CTA (37%; 95% CI, 0.21-0.55 vs. 55%; 95% CI, 0.44-0.65). However, improvements in appropriate use were not observed after the publication of appropriate use criteria for stress echocardiography (53%; 95% CI, 0.45-0.61 vs. 52%; 95% CI, 0.42-0.61) or single-photon emission CT (72%; 95% CI, 0.66-0.77 vs. 68%; 95% CI, 0.6-0.74).
For transthoracic echocardiography, there was no correlation between proportion of appropriateness and published year for the 2007 appropriate use criteria (P = .36), but a positive correlation for the 2011 appropriate use criteria (P = .01).
The researchers found a decrease in the proportion of appropriateness over time using the 2007 transesophageal echocardiography appropriate use criteria (P = .03) and the 2006 CT appropriate use criteria (P = .02).
There were no associations between appropriateness and publication year for stress echocardiography, CTA or SPECT.
“It is possible that the reduction of imaging tests is unrelated to [appropriate use criteria],” the researchers wrote. “The apparent discordance between [appropriate use criteria] and clinical practice patterns suggests that more objective methods are needed to assess the appropriateness of diagnostic imaging procedures.” – by Erik Swain
Disclosure: The researchers report financial ties with the Farrell Foundation, GE Medical Systems, the Select Foundation and Siemens.