Comparing two methods for determining appropriateness of myocardial perfusion imaging: Criteria from the American College of Cardiology Foundation and the American College of Radiology

Abstract

The two methods for rating the appropriateness of MPI have poor agreement; a potential for disagreement between providers and payers if only one method is used.

More or less appropriate: The new rule of law for cardiac imaging

“…We commonly hear from third party payers that there are innumerable requests for approval based on inappropriate reasons on the part of the referring physician. Based on the current report by Bagrova, 3 we see that the majority of referred patients have appropriate indications for testing, as one would expect given that testing has already been performed. What one might envision is that a broader evaluation of requests for imaging authorization and a greater understanding of denominator of at-risk patients would be immensely informative to the field of cardiac imaging.…”

“…In practice, discordance would arise, for example, when a provider uses one set of criteria and the insurance provider another. This is one of a series of similar articles from this group [3][4][5] and importantly highlights the challenges in implementation and hurdles in consistent results of appropriateness based on utilization of rating systems from the ACC vs. ACR. But, does this matter?…”

“…Most of the current patient series are referred or retrospective cohorts. [3][4][5][6][7] One may speculate as to whether we need to examine those who are not but should have been referred and how the AUC/AC alter (i.e., improve) clinical decision making on the part of the referring physician. A more detailed evaluation of available population data would be helpful including knowledge of the denominator of appropriate or inappropriate candidates and their course of care.…”

What’s accepted is not always appropriate!

“…This is one of a series of reports from this group on the utility of appropriate use criteria in guiding optimal referral patterns to stress myocardial perfusion imaging. [3][4][5][6][7] In this report, the authors report that there was poor concordance between appropriate use criteria developed by the ACC as compared to the ACR, with a kappa statistic of 0.32-supporting modest agreement between the two statements. As there is no definitive ''gold standard'' for appropriate indications, this finding of modest concordance is reason for caution and pause as to whether variability in practice patterns will be observed.…”

“…These referral indications have been summarized in recent appropriate use statements from the American College of Cardiology (ACC) and American College of Radiology (ACR). 1,2 In this issue of the Journal of Nuclear Cardiology, 3 Bagrova and colleagues provide a comparison of the concordance between appropriate use indications based on published statements from the ACC and ACR. This is one of a series of reports from this group on the utility of appropriate use criteria in guiding optimal referral patterns to stress myocardial perfusion imaging.…”