Temporal trends in utilization of cardiac computed tomography

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.