Related Experiment Video
Updated: Mar 17, 2026
Signal Acquisition, Score Interpretation, and Economics of a Non-Invasive Point-of-Care Test for Coronary Artery Disease
Published on: August 9, 2024
Underutilization of Coronary Artery Disease Testing Among Patients Hospitalized With New-Onset Heart Failure
Darshan Doshi1, Ori Ben-Yehuda2, Machaon Bonafede3
1Division of Cardiology, Columbia University Medical Center/New York-Presbyterian Hospital, New York, New York.
Insights
Most patients hospitalized for new heart failure (HF) do not receive timely ischemic coronary artery disease (CAD) testing or revascularization, indicating underutilization of essential cardiac assessments.
Area of Science:
- Cardiology
- Public Health
Background:
- Ischemic coronary artery disease (CAD) is a primary cause of heart failure (HF).
- Current practices for assessing ischemic CAD in new-onset HF patients are not well-documented.
Purpose of the Study:
- To analyze the utilization patterns of ischemic CAD testing and revascularization in patients diagnosed with new-onset HF.
Main Methods:
- Retrospective cohort study utilizing commercial and Medicare databases (2010-2013).
- Examined noninvasive and invasive ischemic CAD testing and revascularization rates within 90 days of inpatient HF diagnosis.
Main Results:
- Only 17.5% of 67,161 new-onset HF patients received ischemic CAD testing during index hospitalization, rising to 27.4% by 90 days.
- Revascularization rates were low: 2.1% during index hospitalization and 4.3% by 90 days.
- Patients with prior CAD diagnoses had higher odds of undergoing both noninvasive and invasive ischemic testing.
Conclusions:
- A significant majority of new-onset HF patients do not undergo recommended ischemic CAD evaluation.
- There appears to be substantial underutilization of diagnostic and therapeutic interventions for ischemic CAD in this patient population.
Background:
Although ischemic coronary artery disease (CAD) is the most common etiology of heart failure (HF), the extent to which patients with new-onset HF actually undergo an ischemic work-up and/or revascularization is not well defined.
Objectives:
This study sought to analyze the patterns of testing for ischemic CAD and revascularization in patients with new-onset HF.
Methods:
This was a retrospective cohort study using Truven Health MarketScan Commercial and Medicare databases from 2010 to 2013. The occurrence of noninvasive and invasive ischemic CAD testing and revascularization procedures were examined among patients with new inpatient HF diagnoses during the index hospitalization and within 90 days of admission.
Results:
Among 67,161 patients identified with new-onset HF during an inpatient hospitalization, only 17.5% underwent testing for ischemic CAD during the index hospitalization, increasing to 27.4% at 90 days. Among patients with new-onset HF, only 2.1% underwent revascularization during the index hospitalization for HF; by 90 days, the revascularization rate had increased to 4.3%. Of the tests performed for ischemic CAD, stress testing (nuclear stress testing or stress echocardiography) was performed in 7.9% of new-onset HF patients during the index hospitalization (14.6% within 90 days), whereas coronary angiography was performed in 11.1% of patients during the index hospitalization (16.5% within 90 days). In adjusted analyses, HF patients carrying a baseline diagnosis of CAD had greater odds of noninvasive ischemic testing (odds ratio: 1.25; 95% confidence interval: 1.17 to 1.33; p < 0.0001), as well as invasive ischemic testing (odds ratio: 1.93; 95% confidence interval: 1.83 to 2.05; p < 0.0001), at the index hospitalization than those without baseline CAD.
Conclusions:
The majority of patients hospitalized for new-onset HF did not receive testing for ischemic CAD either during hospitalization or within 90 days, which suggests significant underutilization of ischemic CAD assessment in new-onset HF patients.
Related Concept Videos
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:26Imbalances in Cardiac Output
CHF can occur due to the failure of either side of the heart. Left-side failure leads to pulmonary congestion—the right side continues to send...
01:27Coronary Artery Disease V: Interprofessional Care
01:17Pathophysiology of Heart Failure
01:30Dysrhythmias V: Evaluating Dysrhythmias
01:28Cardiac Catheterization I: Pre-Procedure Overview