Impact of Insurance Carrier, Prior Authorization, and Socioeconomic Status on Appropriate Use of <scp>SPECT</scp> Myocardial Perfusion Imaging in Private Community‐Based Office Practice

Doukky, Rami; Hayes, Kathleen; Frogge, Nathan; Nazir, Noreen; Collado, F.; Williams, Kim A.

doi:10.1002/clc.22382

Cited by 12 publications

(10 citation statements)

References 32 publications

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“…A recent study showed that SPECT MPI is widely used for diagnostic and risk stratification purposes in the United States and patient’s socio-economic status did not significantly affect the use of SPECT MPI by physicians[15]. In the developing world several studies have shown the widespread use of SPECT MPI by physicians to aid in diagnosis in management[16,17].…”

Section: Discussionmentioning

confidence: 99%

Significance of inferior wall ischemia in non-dominant right coronary artery anatomy

Malik

Abela

Devabhaktuni

et al. 2017

WJC

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AIMTo investigate the relationship of inferior wall ischemia on myocardial perfusion imaging in patients with non-dominant right coronary artery anatomy.METHODSThis was a retrospective observational analysis of consecutive patients who presented to the emergency department with primary complaint of chest pain. Only patients who underwent single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) were included. Patients who showed a reversible defect on SPECT MPI and had coronary angiography during the same hospitalization was analyzed. Patients with prior history of coronary artery disease (CAD) including history of percutaneous coronary intervention and coronary artery bypass graft surgerys were excluded. True positive and false positive results were identified on the basis of hemodynamically significant CAD on coronary angiography, in the same territory as identified on SPECT MPI. Coronary artery dominance was determined on coronary angiography. Patients were divided into group 1 and group 2. Group 1 included patients with non-dominant right coronary artery (RCA) (left dominant and codominant). Group 2 included patients with dominant RCA anatomy. Demographics, baseline characteristics and positive predictive value (PPV) were analyzed for the two groups.RESULTSThe mean age of the study cohort was 57.6 years. Sixty-one point seven percent of the patients were males. The prevalence of self-reported diabetes mellitus, hypertension and dyslipidemia was 36%, 71.9% and 53.9% respectively. A comparison of baseline characteristics between the two groups showed that patients with a non-dominant RCA were more likely to be men. For inferior wall ischemia on SPECT MPI, patients in study group 2 had a significantly higher PPV, 32/42 (76.1%), compared to patients in group 1, in which only 3 out of the 29 patients (10.3%) had true positive results (P value < 0.001 Z test). The difference remained statistically significant even when only patients with left dominant coronary system (without co-dominant) were compared to patients with right dominant system (32/40, 76.1% in right dominant group, 3/19, 15.8% in left dominant group, P value < 0.001 Z test). There was no significant difference in mean hospital stay, re-hospitalization, and in-hospital mortality between the two groups.CONCLUSIONThe positive predictive value of SPECT MPI for inferior wall ischemia is affected by coronary artery dominance. More studies are needed to explain this phenomenon.

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Section: Discussionmentioning

confidence: 99%

Significance of inferior wall ischemia in non-dominant right coronary artery anatomy

Malik

Abela

Devabhaktuni

et al. 2017

WJC

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“…48–50 Another strategy that has been considered is prior authorization, although a recent analysis on this strategy suggests no effect on the rate of inappropriate MPI among patients insured by private carriers as compared to Medicare which does not implement prior authorization measures. 51 …”

Section: Discussionmentioning

confidence: 99%

Outcomes after inappropriate nuclear myocardial perfusion imaging: A meta-analysis

Elgendy

Mahmoud

Shuster

et al. 2016

Journal of Nuclear Cardiology

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Background The relationship between inappropriate MPI and cardiovascular outcomes is poorly understood. We sought to systematically review the literature on appropriate use criteria (AUC) for MPI, including temporal trend of inappropriate testing and resulting cardiovascular outcomes. Methods We searched the MEDLINE database for studies related to AUC and MPI. The co-primary outcomes were abnormal test results and the presence of cardiac ischemia. Random effects odds ratios (OR) were constructed using DerSimonian-Laird method. Results A total of 22 studies with 23,443 patients were included. The prevalence of inappropriate testing was 14.8 % [95% confidence interval (CI) 11.6–18.7%]. Inappropriate MPI studies were less likely to be abnormal (OR 0.41 95% CI 0.35–0.49, p<0.0001) and to demonstrate ischemia (OR 0.40, 95% CI 0.24–0.67, p<0.0001) compared to appropriate testing. No difference in the rate of inappropriate tests was detected based on the midpoint of the enrollment year (p=0.54). The pattern of ordering inappropriate studies was not different between cardiology and non-cardiology providers (OR 0.74, 95% CI 0.51–1.06, p=0.10). Conclusion Inappropriate MPI studies are less likely to yield abnormal results or demonstrate myocardial ischemia. The rate of inappropriate MPI has not decreased over time.

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“…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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Impact of Insurance Carrier, Prior Authorization, and Socioeconomic Status on Appropriate Use of SPECT Myocardial Perfusion Imaging in Private Community‐Based Office Practice

Cited by 12 publications

References 32 publications

Significance of inferior wall ischemia in non-dominant right coronary artery anatomy

Significance of inferior wall ischemia in non-dominant right coronary artery anatomy

Outcomes after inappropriate nuclear myocardial perfusion imaging: A meta-analysis

Improving Appropriateness and Quality in Cardiovascular Imaging

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