Common Reasons That Asymptomatic Patients Who Are 65 Years and Older Receive Carotid Imaging

Keyhani, Salomeh; Cheng, Eric M.; Naseri, Ayman; Halm, Ethan A.; Williams, Linda S.; Johanning, Jason M.; Madden, Erin; Rofagha, Soraya; Woodbridge, Alexandra; Abraham, Ann; Ahn, Rosa; Saba, Susan; Eilkhani, Elnaz; Hebert, Paul L.; Bravata, Dawn M.

doi:10.1001/jamainternmed.2016.0678

Cited by 18 publications

(18 citation statements)

References 16 publications

(20 reference statements)

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“…This finding may be important for predicting the impact of efforts to reduce overuse, such as the Choosing Wisely initiative. [26][27][28] Our study has some limitations. Focus groups rely on selfreport and are prone to recall and social desirability biases.…”

Section: Discussionmentioning

confidence: 94%

Older Adults’ Perceptions of the Causes and Consequences of Healthcare Overuse: A Qualitative Study

2018

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Section: Discussionmentioning

confidence: 94%

Older Adults’ Perceptions of the Causes and Consequences of Healthcare Overuse: A Qualitative Study

2018

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“…This finding suggests that there may not be overuse of follow-up imaging in patients with low-grade stenosis, as commonly debated. 4,15 The lack of follow-up imaging in our cohort also underlines the lack of outcome-based recommendations for follow-up of low-grade stenosis.…”

Section: Discussionmentioning

confidence: 87%

Recommendations for Low‐Grade Carotid Stenosis Follow‐up Based on a Single‐Institution Database

Bennett

Bluth

Larson

et al. 2017

J of Ultrasound Medicine

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We provide evidence-based follow-up recommendations for patients who have low degrees of carotid stenosis. Different degrees of carotid stenosis progress at different rates and therefore should be followed at different intervals. Additionally, the most patients in our database showed 1% to 39% stenosis and did not have any follow-up imaging, suggesting that carotid ultrasound may not be overused for low degrees of stenosis.

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“…This finding is consistent with prior literature indicating that there are many reasons physicians order carotid imaging, most of which are of uncertain clinical significance. 14 …”

Section: Discussionmentioning

confidence: 99%

“… 13 Carotid imaging is performed for many indications other than stroke evaluation, the appropriateness of which are often uncertain. 14 When patients who received carotid imaging for uncertain indications are found to have carotid stenosis, they may be offered a revascularization procedure for primary stroke prevention, exposing them to periprocedural risk of stroke, death, and myocardial infarction despite evolving evidence that suggests a potential lack of benefit. 15 , 16 As a result, carotid imaging has been a target of multiple Choosing Wisely recommendations.…”

Section: Introductionmentioning

confidence: 99%

Trends in Low-Value Carotid Imaging in the Veterans Health Administration From 2007 to 2016

et al. 2020

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Key Points Question How has utilization of low-value carotid imaging for carotid bruits, preoperative evaluation, and syncope changed in the Veterans Health Administration system from 2007 to 2016? Findings In this serial cross-sectional study of 809 071 carotid imaging examinations in the national Veterans Affairs Health system, there was a modest decrease in rates of imaging for carotid bruits that predated Choosing Wisely recommendations, and no significant trends in rates of preoperative carotid imaging or imaging for syncope. Meaning These findings suggest that to reduce low-value testing and utilization cascades, interventions targeting ordering clinicians are needed to augment the impact of public awareness campaigns.

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Common Reasons That Asymptomatic Patients Who Are 65 Years and Older Receive Carotid Imaging

Cited by 18 publications

References 16 publications

Older Adults’ Perceptions of the Causes and Consequences of Healthcare Overuse: A Qualitative Study

Older Adults’ Perceptions of the Causes and Consequences of Healthcare Overuse: A Qualitative Study

Recommendations for Low‐Grade Carotid Stenosis Follow‐up Based on a Single‐Institution Database

Trends in Low-Value Carotid Imaging in the Veterans Health Administration From 2007 to 2016

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