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Temporal changes in appropriateness of cardiac imaging


Fonseca, R and Negishi, K and Otahal, P and Marwick, TH, Temporal changes in appropriateness of cardiac imaging, Journal of the American College of Cardiology, 65, (8) pp. 763-773. ISSN 0735-1097 (2015) [Refereed Article]

Copyright Statement

Copyright 2015 By the American College of Cardiology Foundation

DOI: doi:10.1016/j.jacc.2014.11.057


Background: Appropriate use criteria (AUC) for cardiac imaging have been available for almost 10 years. The extent to which there has been a reported improvement in appropriate use is undefined.

Objectives: This study systematically reviewed published evidence to identify whether the promulgation of AUC has led to an improvement in the proportion of appropriate cardiac imaging requests.

Methods: Electronic databases were systematically searched for English-language papers related to AUC and cardiovascular imaging. We found 59 reports involving 103,567 tests that were published from 2000 to 2012. The rate of appropriate testing over time was analyzed in a meta-regression.

Results: New AUC were associated with apparent improvements in appropriateness for transthoracic echocardiography (TTE) (80% [95% confidence interval (CI): 0.75 to 0.84] vs. 85% [95% CI: 0.81 to 0.89]), transesophageal echocardiography (TEE) (89% [95% CI: 0.81 to 0.94] vs. 95% [95% CI: 0.93 to 0.96]) and computed tomography angiography (CTA) (37% [95% CI: 0.21 to 0.55] vs. 55% [95% CI: 0.44 to 0.65]) but not stress echocardiography (53% [95% CI: 0.45 to 0.61] vs. 52% [95% CI: 0.42 to 0.61]) or single-photon emission computed tomography (72% [95% CI: 0.66 to 0.77] vs. 68% [95% CI: 0.60 to 0.74]). Although there were no correlations between the proportion of appropriate TTEs and published year (p = 0.36) for 2007 AUC, there was a positive correlation between proportion of appropriateness and the year of publication (p = 0.01) for 2011 AUC. There was a significant decrease in the proportion of appropriateness over time using the 2007 TEE AUC (p = 0.03) and 2006 CT AUC (pp = 0.02). There were no meaningful associations between appropriateness and publication year for stress echocardiography, CTA, or single-photon emission computed tomography.

Conclusions: Rates of reported appropriate use in imaging show improvements for TTE and CTA but not for stress imaging and TEE. The observed reductions in imaging studies are not matched by reported rates of appropriate use.

Item Details

Item Type:Refereed Article
Keywords:appropriate use criteria, cardiac imaging, echocardiography, nuclear medicine, tomography
Research Division:Biomedical and Clinical Sciences
Research Group:Cardiovascular medicine and haematology
Research Field:Cardiology (incl. cardiovascular diseases)
Objective Division:Health
Objective Group:Clinical health
Objective Field:Clinical health not elsewhere classified
UTAS Author:Fonseca, R (Mr Ricardo Fonseca Diaz)
UTAS Author:Negishi, K (Dr Kazuaki Negishi)
UTAS Author:Otahal, P (Mr Petr Otahal)
UTAS Author:Marwick, TH (Professor Tom Marwick)
ID Code:98821
Year Published:2015
Web of Science® Times Cited:62
Deposited By:Menzies Institute for Medical Research
Deposited On:2015-03-04
Last Modified:2017-11-01

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