This article is more than 5 years old. Information may no longer be current.
Myocardial perfusion imaging use declined substantially
Click Here to Manage Email Alerts
The use of myocardial perfusion imaging declined substantially from 2006 to 2011, and the drop cannot be explained solely by increases in use of other modalities, according to a research letter published in JAMA.
“Although the abrupt nature of the decline suggests changing physician behavior played a major role, incident coronary disease, as assessed by MI, also declined,” Edward J. McNulty, MD, of Kaiser Permanente Medical Center, San Francisco, and colleagues wrote. “We could not determine the relative effects of these factors on [myocardial perfusion imaging] use.”
The researchers analyzed patient-level data from 2000 to 2011 for myocardial perfusion imaging (MPI) for adults aged at least 30 years from the clinical databases of Kaiser Permanente Northern California. They calculated age- and sex-adjusted annual rates of MPI tests per 100,000 person-years. Logistic regression was used to assess interactions of age, sex, inpatient vs. outpatient setting and prior coronary revascularization on trends. The researchers also estimated annual rates of cardiac CT and stress echocardiography to assess potential substitution of other imaging modalities, and determined trends in MI to assess trends in incident coronary disease.
Use of MPI increased by 41% from 2000 to 2006 (P<.001). However, MPI use declined by 51% from 2006 to 2011 (adjusted OR for 2011 vs. 2006=0.51; 95% CI, 0.44-0.6).
The decline was greater for outpatients compared with inpatients (58% vs. 31%; P<.001) and for people younger than 65 years compared with those aged at least 65 years (56% vs. 47%; P<.001). Use did not differ by sex or by revascularization history, McNulty and colleagues wrote.
Use of stress echocardiography did not change between 2007 (189 tests per 100,000 patient-years) and 2011 (182 tests per 100,000 patient-years; P=.93). While use of cardiac CT increased from 2007 (37 tests per 100,000 patient-years) to 2011 (73 tests per 100,000 patient-years; P=.01), it could have accounted for no more than 5% of the decline in overall MPI use, the researchers found.
During the period of declining overall MPI use, the rate of incident MI also decreased by 27% (P<.001), from 286 events per 100,000 patient-years to 208 events per 100,000 patient-years.
“The observed decline occurred in the context of a health care delivery system without direct financial incentives to perform tests,” McNulty and colleagues wrote. “Nevertheless, the substantial reduction in MPI use demonstrates the ability to reduce testing on a large scale with anticipated reductions in health care costs.”
Disclosure: The study was supported by a grant from the Kaiser Permanente Northern California Community Benefits Program. Four researchers are employees of and one researcher is a consultant for Kaiser Permanente. One researcher reports receiving research grant support from Genentech.
Click Here to Manage Email Alerts