Temporal trends in the utilization of diagnostic testing and treatments for cardiovascular disease in the United...

Area of Science:

• Cardiology
• Health Services Research
• Public Health

Background:

• Rising rates of invasive cardiac testing and treatment contrast with limited data on noninvasive testing trends.
• Coronary artery disease (CAD) management involves both invasive and noninvasive diagnostic and therapeutic procedures.

Purpose of the Study:

• To analyze temporal trends in noninvasive and invasive cardiac service utilization.
• To correlate these trends with changes in cardiac disease prevalence.
• To assess if increased utilization targeted underserved populations.

Main Methods:

• Annual cross-sectional study of Medicare fee-for-service beneficiaries (1993-2001).
• Population-based rates calculated for stress testing, cardiac catheterization, revascularization, and acute myocardial infarction hospitalizations.
• Rates adjusted for age, gender, and race.

Main Results:

• Utilization rates for most cardiac services nearly doubled between 1993 and 2001.
• Acute myocardial infarction hospitalization rates remained stable.
• Despite overall increases, disparities in cardiac testing and treatment between nonblack men and other subgroups persisted.

Conclusions:

• Increased cardiac service utilization is not explained by shifts in disease prevalence.
• Growing use of cardiac services has not reduced existing gender and racial disparities in treatment.
• Potential for increased risk and cost without commensurate benefit in certain populations.