Author + information
- Hong Jun Yun,
- Jessica Lehrich,
- Shashank S. Sinha,
- Richard L. Weinberg,
- Brahmajee K. Nallamothu and
- Venkatesh L. Murthy
Background: Utilization of single photon emission computed tomography myocardial perfusion imaging (SPECT MPI) has declined, yet the etiology remains unclear. We sought to elucidate whether this phenomena is due to better patient selection or indiscriminate reduction in use regardless of appropriateness.
Methods: We used the 20% random sample of Medicare Part B carrier claims files for 2008-2012 to calculate rates per 1000 beneficiaries for SPECT MPI and rates of downstream cardiac catheterization and revascularization procedures < 90 days. We evaluated whether yield of SPECT MPI, as measured by the proportion of downstream angiography leading to revascularization, increased in the setting of decreased utilization across hospital referral regions (HRRs).
Results: From 2008 to 2012, rates of SPECT MPI declined markedly (67.2 to 45.8 per 1000). Rates of downstream cardiac catheterization and revascularization procedures remained stable from 12.4% to 11.7% and 5.0% to 4.5%, respectively. Across 306 HRRs, changes in downstream catheterization and revascularization rates were highly correlated to changes in rates of SPECT MPI (Pearson R=0.85 and 0.77, respectively; P<0.0001 for both). The yield of SPECT MPI did not improve during the study period (Pearson R=-0.02, P=0.65).
Conclusions: Large declines in SPECT MPI are not matched by improvements in the yield of these studies, suggesting efforts to focus non-invasive stress testing on patients with higher pre-test probability have not been successful.
Poster Hall, Hall C
Friday, March 17, 2017, 10:00 a.m.-10:45 a.m.
Session Title: Traditional and Novel Factors Used to Assess the Risk of, and Used for the Treatment of, Coronary Artery Disease
Abstract Category: 2. Acute and Stable Ischemic Heart Disease: Clinical
Presentation Number: 1126-331
- 2017 American College of Cardiology Foundation