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AUC scores for cardiac radionuclide imaging were developed in 2009 and endorsed by national societies. AUC scores are increasingly being monitored by insurers and quality assessors. It is not known what factors impact AUC scores in the community setting.
Retrospective chart review of all SPECT MPI studies in a single, multi-site suburban, outpt cardiology practice for calendar year 2011.
Of the 2962 imaged pts, mean age was 63 yrs with 44% males. Hypertension (83%), hyperlipidemia (69%) were common, while diabetes (31%), smoking (14%) and prior vascular disease (35%) were less. Angina or an equivalent was documented in 69%, while 11% were pre op assessments and 34% had a high Framingham Risk Score. Prior MPI study was available in 42%. The majority, 55% underwent pharmacological stress. Overall 70% of studies were normal, 16% had a fixed defect and 12% had a reversible defect. The mean EF was 58%. Only 9% went on to cath with 28% of these being normal. The Astellas smartphone app was used to calculate AUC scores. MPI studies deemed “appropriate” (AUC score 7-9) totaled 56%, “uncertain” (AUC score 4-6) were 18% and “inappropriate” (AUC score 1-3) were 21%. Pts under the age of 50 yrs were more likely to have a lower AUC score (mean 5.1 vs 6.5, p<0.001) Females were more likely to undergo an inappropriate study (24 vs 15%, p<0.001). Clinical characteristics varied significantly, p=0.005 between ethnic groups and there was a trend towards higher AUC scores in blacks vs white pts (mean 6.18 vs 6.30, p=0.093). Inappropriate scores varied between testing site (range 17 to 22%, p<0.001) and by ordering physician (range 12 to 34%,p<0.001)
Our findings suggest that one fifth of outpt nuclear imaging studies would be deemed “inappropriate” by current AUC scoring methodology. Younger pts, female gender, site of testing and ordering physician significantly impacted AUC scores. While inadequate documentation and differing pt characteristics could explain some of these results, further analysis and validation in a broader setting is needed. Confirmation of these findings could have significant implications for future reimbursement and quality indicators.
Poster Sessions, Expo North
Saturday, March 09, 2013, 10:00 a.m.-10:45 a.m.
Session Title: Appropriateness and Gaps in Care
Abstract Category: 28. Quality of Care and Outcomes Assessment
Presentation Number: 1116-110
- 2013 American College of Cardiology Foundation