Author + information
- Marcio Sommer Bittencourt,
- Mitalee Patil,
- Edward Hulten,
- Hicham Skali,
- Raymond Kwong,
- Jon Hainer,
- Daniel Forman,
- Sharmila Dorbala,
- Marcelo Di Carli and
- Ron Blankstein
Our objective was to evaluate whether referring physician specialty impacts the use of non-invasive as well as invasive downstream testing after exercise treadmill testing (ETT).
All consecutive patients with no prior history of CAD (N=3, 651) who were referred for clinical ETT at a large academic medical center over a 2 year period were included. Downstream imaging tests included nuclear perfusion imaging, coronary CT angiography, stress echocardiography, stress MRI, and invasive coronary angiography (IA) performed up to 6 months after the initial ETT. Referring physicians were categorized as cardiologists and non-cardiologists.
The ETT results were negative in 2876 (79%), positive in 132 (3.6%) and inconclusive in 643 (18%) of patients. Patients referred by non-cardiologists had a similar number of normal (78.8% vs. 78.8%), positive (3.6% vs. 3.7%) and inconclusive ETT results (17.7% vs. 17.5) (p=0.998). The rates of downstream testing after initial ETT is presented in Figure 1.
Patients referred for ETT by cardiologists are less likely to have additional downstream testing, particularly non-invasive imaging tests, than those referred by non-cardiologists. The lower rate of testing is mainly driven by a lower rate of downstream testing following positive or inconclusive ETT Results. While further outcomes data are needed, these findings may have important potential implications on resource utilization and cost.
Poster Sessions, Expo North
Sunday, March 10, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Disparities and Cardiovascular Epidemiology
Abstract Category: 28. Quality of Care and Outcomes Assessment
Presentation Number: 1244-99
- 2013 American College of Cardiology Foundation