Temporal changes in appropriateness of cardiac imaging

Area of Science:

• Cardiovascular Imaging
• Health Services Research
• Medical Guidelines

Background:

• Appropriate Use Criteria (AUC) for cardiac imaging have existed for nearly a decade, yet their impact on improving the appropriateness of imaging requests remains unclear.
• This systematic review evaluates the evidence on whether the implementation of AUC has led to an increase in the proportion of appropriate cardiac imaging requests.

Discussion:

• Meta-regression analysis of 59 reports (103,567 tests) from 2000-2012 revealed varied impacts of AUC on imaging appropriateness.
• While new AUC correlated with improved appropriateness for transthoracic echocardiography (TTE) and computed tomography angiography (CTA), stress echocardiography and single-photon emission computed tomography (SPECT) showed no significant changes.
• A concerning trend of decreasing appropriateness over time was observed for transesophageal echocardiography (TEE) and CT angiography when using specific older AUC guidelines.

Key Insights:

• Appropriateness rates improved for TTE (80% to 85%) and CTA (37% to 55%) following new AUC.
• Stress echocardiography (53% to 52%) and SPECT (72% to 68%) showed no improvement in appropriate use.
• A positive correlation between appropriateness and publication year was noted for 2011 AUC for TTE, but not for earlier guidelines.

Outlook:

• Further research is needed to understand the factors influencing the varied effectiveness of AUC across different cardiac imaging modalities.
• Strategies to enhance the appropriate use of stress imaging and TEE require development and evaluation.
• The findings suggest that while AUC can be beneficial, their implementation and impact require ongoing monitoring and refinement to ensure optimal utilization of cardiac imaging resources.