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Published on: April 18, 2013
Temporal trends in utilization of cardiac computed tomography
Ala-Eddin M Ayyad1, Jason Cole, Asmir Syed
1Cleveland Clinic, Heart and Vascular Institute, Cleveland, OH, USA.
Insights
The appropriateness of cardiac computed tomography (CT) use improved after 2006 guidelines were published, with more appropriate and fewer inappropriate CT scans ordered. Cardiologists showed higher appropriateness in ordering these cardiac CT examinations.
Area of Science:
- Cardiology
- Radiology
- Medical Informatics
Background:
- A 2006 multisociety document established criteria for appropriate, inappropriate, and uncertain indications for cardiac computed tomography (CT).
- The study aimed to assess the impact of these 2006 criteria on the appropriateness of cardiac CT utilization.
Purpose of the Study:
- To compare the appropriateness of cardiac CT examinations before and after the publication of multisociety guidelines in 2006.
- To evaluate changes in the utilization patterns of cardiac CT based on established appropriateness criteria.
Main Methods:
- Retrospective evaluation of cardiac CT examinations performed in early 2006 and 2007 at a major academic center and a private cardiology practice.
- Classification of CT examinations as appropriate, inappropriate, uncertain, or uncategorized based on patient medical records and 2006 appropriateness criteria.
- Analysis of 1409 patient examinations to determine trends in utilization appropriateness.
Main Results:
- The proportion of appropriate cardiac CT examinations significantly increased from 69.5% in 2006 to 78.5% in 2007 (P = 0.001).
- Inappropriate cardiac CT examinations decreased from 11.5% in 2006 to 4.6% in 2007 (P = 0.001).
- No significant change was observed in the rate of uncertain cardiac CT examinations (12.7% in 2006 vs. 13.3% in 2007).
Conclusions:
- Publication of the 2006 multisociety guidelines led to a significant increase in appropriate cardiac CT utilization and a decrease in inappropriate use.
- Cardiologists demonstrated a higher likelihood of ordering appropriate cardiac CT examinations compared to non-cardiologists.
- The findings suggest successful implementation and impact of evidence-based guidelines on clinical practice for cardiac CT ordering.
Background:
Appropriate, inappropriate, and uncertain indications for the use of cardiac computed tomography (CT) were defined by a multisociety document in 2006. We sought to compare the appropriateness of cardiac CT examinations before and after these criteria were published.
Methods:
We retrospectively evaluated all patients presenting for cardiac CT examinations in the first 3 months of 2006 and 2007 at a large academic medical center and an unaffiliated large cardiology group private practice. The indication for the examinations were determined from the patients' medical records. The examinations were then classified as "appropriate," "inappropriate," or "uncertain," based on appropriateness criteria. Examinations that did not fall into any of these categories were classified as "uncategorized."
Results:
We evaluated a total of 1409 patients (64.9% men; mean age, 57.6 +/- 13.4 years). The proportion of appropriate CT examinations increased from 69.5% during the study period in 2006 to 78.5% in 2007 (P = 0.001). A corresponding decrease was observed in inappropriate CT examinations from 11.5% in 2006 to 4.6% in 2007 (P = 0.001). No change was observed in the number of CT examinations that were deemed uncertain (12.7% in 2006, and 13.3% in 2007; P = NS).
Conclusion:
The number of CT examinations considered appropriate increased during the study period, whereas the number of inappropriate examinations decreased. Cardiologists were more likely than noncardiologists to order examinations that were appropriate during the study period.
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