Appropriate utilization of cardiac computed tomography for the assessment of stable coronary artery disease

Abstract

Background Appropriate use criteria (AUC) have been developed in response to growth in cardiac imaging utilization and concern regarding associated costs. Cardiac computed tomography angiography (CCTA) has emerged as an important modality in the evaluation of coronary artery disease, however its appropriate utilization in actual practice is uncertain. Our objective was to determine the appropriate utilization of CCTA in a large quaternary care institution and to compare appropriate utilization pre and post publication of the 2013 AUC guidelines. We hypothesized that the proportion of appropriate CCTA utilization will be similar to those of other comparable cardiac imaging modalities and that there would be a significant increase in appropriate use post AUC publication. Methods We employed a retrospective cohort study design of 2577 consecutive patients undergoing CCTA between January 1, 2012 and December 30, 2016. An appropriateness category was assigned for each CCTA. Appropriateness classifications were compared pre- and post- AUC publication via the chi-square test. Results Overall, 83.5% of CCTAs were deemed to be appropriate based on the AUC. Before the AUC publication, 75.0% of CCTAs were classified as appropriate whereas after the AUC publication, 88.0% were classified as appropriate (p < 0.001). The increase in appropriate utilization, when extrapolated to the Medicare population of the United States, was associated with potential cost savings of approximately $57 million per year. Conclusions We report a high rate of appropriate use of CCTA and a significant increase in the proportion of CCTAs classified as appropriate after the AUC publication.

Measuring appropriateness of diagnostic imaging: a scoping review

“…Five included studies (10%) were interventional studies [83,87,97,106,107]. The analyzed interventions included guideline implementations [83,87,107], radiological consultations [97] for residents and clinical decision support systems [106].…”

“…Five included studies (10%) were interventional studies [83,87,97,106,107]. The analyzed interventions included guideline implementations [83,87,107], radiological consultations [97] for residents and clinical decision support systems [106]. Two guideline implementations [83,107] and clinical decision support [106] showed significantly improved appropriateness results.…”

“…The analyzed interventions included guideline implementations [83,87,107], radiological consultations [97] for residents and clinical decision support systems [106]. Two guideline implementations [83,107] and clinical decision support [106] showed significantly improved appropriateness results. Radiological consultation did not reveal significant changes [97].…”

“…Six studies about heart and/or vessel imaging [77,80,86,101,102,107] were included. They reviewed 35 adult MRIs [80,101], two pediatric MRIs [80] and 4836 adult CTs [77,86,101,102,107]. Two adult MRI studies report heterogeneous appropriateness rates of 100% (ACR AC: Fig.…”

“…One study reviewing two pediatric heart/vessel MRIs reported an appropriateness of 100% [80]. For CT, the overall appropriateness according to ACR AC [77,101] or national guidelines [86,102,107] was 84% (n = 4052/4836). The number of reviewed CTs varied between 32 [101], 243 [77], 1984 [102] and 2577 [107].…”