Comparison of the 2006 and 2010 Cardiac CT Appropriateness Criteria in a Real-World Setting

Mazimba, Sula; Grant, Nakash; Parikh, Analkumar; Patel, Trupti; Dahale, Bhakti; Franco, Zurisadai; Dittoe, Nathaniel; Shah, Tushar; Hahn, Harvey S.

doi:10.1016/j.jacr.2012.04.016

Cited by 12 publications

(9 citation statements)

References 19 publications

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“…We found that the proportion of uncertain (26%) rating was higher than that in previous studies (3% - 16%) (Cullen et al 2013; Wasfy et al 2012; Mazimba et al 2012). One of the major reasons was the increase in CT examinations for detection of CAD in asymptomatic patients.…”

Section: Discussioncontrasting

confidence: 69%

Evaluation of appropriateness of second-generation 320-row computed tomography for coronary artery disease

et al. 2015

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The influence of newer-generation CT on the clinical indications and appropriateness of cardiac CT has not been adequately surveyed. We aimed to evaluate the distribution of appropriateness ratings and test the outcomes of cardiac CT using second-generation 320-row CT. The 2010 appropriate use criteria (AUC) were applied at the point of service to a consecutive series of patients (N = 309) who were referred for cardiac CT. The CT indication was determined based on interviews and medical records. The proportions of patients within the categories of appropriate (A), uncertain (U), inappropriate (I), and not covered were described. The prevalence of significant coronary artery disease (CAD) was also compared among the categories. The proportions were 49.2%, 25.9%, and 20.7% for appropriate, uncertain, and inappropriate indication, respectively. The indication that was not covered was only 4.2%. Significant CAD was more frequently observed for uncertain- than appropriate indication (42.5% vs 27.6%; P = 0.03), although the number of significant stenosed segments was not different (P = 0.13). The recent advancement of cardiac CT increased the proportion of uncertain scans, which were associated with a high prevalence of significant CAD.

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Section: Discussioncontrasting

confidence: 69%

Evaluation of appropriateness of second-generation 320-row computed tomography for coronary artery disease

et al. 2015

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“…4 Between 7% and 23% of transthoracic echocardiograms (TTE) are deemed to be inappropriate, [5][6][7][8] and 28% to 30% of stress echocardiograms (SE) may be performed for inappropriate indications, [9][10][11][12] whereas only 1% to 3% of transoesphageal echocardiograms (TEE) are inappropriate. 8,13,14 Between 9% and 44% of cardiac CT studies are inappropriate, [15][16][17] and 4% to 46% of SPECT studies have been classified as inappropriate. [18][19][20][21][22] No studies related to cardiac magnetic resonance imaging (CMR) were identified.…”

Section: Improving Appropriateness Of Cardiovascular Imaging Approprimentioning

confidence: 99%

Improving Appropriateness and Quality in Cardiovascular Imaging

Bhattacharyya

Lloyd

2015

Circ: Cardiovascular Imaging

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Abstract-High-quality cardiovascular imaging requires a structured process to ensure appropriate patient selection, accurate and reproducible data acquisition, and timely reporting which answers clinical questions and improves patient outcomes. Several guidelines provide frameworks to assess quality. This article reviews interventions to improve quality in cardiovascular imaging, including methods to reduce inappropriate testing, improve accuracy, reduce interobserver variability, and reduce diagnostic and reporting errors. (Circ Cardiovasc Imaging. 2015;8:e003988.

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“…There have been a small number of previous studies examining the effect of AUC publication on appropriateness of CCTAs [9][10][11][12][13]. For example, a meta-analysis reported that while there was improvement in appropriate utilization of CCTA after publication of the AUC (from 37 to 55%), the overall rate of appropriate utilization remained relatively low [11].…”

Section: Discussionmentioning

confidence: 99%

“…Cardiac computed tomography has become an increasingly utilized imaging modality for a variety of indications, with assessment of coronary artery disease by angiography (cardiac computed tomography angiography; CCTA) being the most common [6,7]. Prior research reported that up to 48% of CCTA referrals may be inappropriate [8,9]. It is currently unclear if publication of the AUC has led to increased rates of appropriate CCTA utilization.…”

Section: Introductionmentioning

confidence: 99%

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

Hammer

Mian

Elhadad

et al. 2021

BMC Cardiovasc Disord

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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.

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Comparison of the 2006 and 2010 Cardiac CT Appropriateness Criteria in a Real-World Setting

Cited by 12 publications

References 19 publications

Evaluation of appropriateness of second-generation 320-row computed tomography for coronary artery disease

Evaluation of appropriateness of second-generation 320-row computed tomography for coronary artery disease

Improving Appropriateness and Quality in Cardiovascular Imaging

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

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