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Use of Initial Noninvasive Cardiac Testing and Association with Downstream Healthcare Resource: A Retrospective
Dana Villines1, Wm Thomas Summerfelt2,3, James R Spalding4
1Advocate Health Care, 814 W. Nelson St, RM2025, Chicago, IL, 60657, USA. Dana.Villines@advocatehealth.com.
Insights
Single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) does not increase downstream healthcare resource utilization compared to exercise treadmill testing (ETT) or echocardiography (ECHO). SPECT-MPI is linked to fewer repeat cardiovascular tests and inpatient visits for patients with suspected myocardial infarction.
Area of Science:
- Cardiology
- Health Services Research
Background:
- Clinical guidelines allow significant discretion in noninvasive cardiac testing for suspected coronary artery disease.
- Repeat testing, emergency department visits, and other cardiac procedures can burden patients and payers.
- Assessing downstream healthcare resource utilization (HCRU) is crucial for treatment planning.
Purpose of the Study:
- To compare downstream HCRU for patients with probable type I myocardial infarction (MI) undergoing initial SPECT-MPI, ECHO, or ETT.
- To evaluate the impact of initial noninvasive cardiac testing on subsequent healthcare utilization and costs.
Main Methods:
- Retrospective analysis of electronic medical records for 12,130 patients with probable type I MI.
- Logistic and linear regression models were used to assess the impact of SPECT-MPI, ETT, and ECHO.
- Outcomes included repeat cardiovascular testing, inpatient visits, outpatient visits, and cardiac-related costs within 12 months.
Main Results:
- SPECT-MPI was the most common index test (56.5%), followed by ETT (29.2%) and ECHO (14.3%).
- Patients undergoing SPECT-MPI had lower odds of repeat cardiovascular testing (OR 0.77) and inpatient visits (OR 0.70) compared to ETT or ECHO.
- ETT and ECHO were not predictive of any measured outcome.
Conclusions:
- SPECT-MPI is not associated with increased downstream HCRU compared to ETT or ECHO.
- SPECT-MPI use is linked to a reduced likelihood of repeat non-invasive cardiovascular testing and inpatient admissions.
- Findings support the role of SPECT-MPI in managing patients with suspected MI while optimizing resource utilization.
Background:
Clinical guidelines provide clinicians with substantial discretion in the use of noninvasive cardiac testing for patients with suspected coronary artery disease. Repeat testing, frequent emergency department (ED) visits, and increases in other cardiac-related procedures can be a burden on patients and payers and can complicate treatment planning. We assessed downstream healthcare resource utilization (HCRU) for patients undergoing initial single-photon emission computed tomography (SPECT), myocardial perfusion imaging (MPI), stress echocardiography (ECHO), or exercise treadmill testing (ETT) with probable type I myocardial infarction (MI).
Methods:
Electronic medical records data from 12,130 patients with probable type I MI presenting to EDs within a large healthcare system comprised of 11 adult hospitals were retrospectively analyzed. Logistic and linear regression determined the individual contribution of SPECT-MPI, ETT, and ECHO on repeat cardiovascular (CV) testing, inpatient visits, outpatient visits, and cardiac-related costs within 12 months of the index visit.
Results:
The majority of patients received SPECT-MPI for the index-testing event (56.5%), followed by ETT (29.2%) and ECHO (14.3%). Patients who had SPECT-MPI at the index visit were less likely to have a repeat CV testing visit (odds ratio [OR] 0.77, 95% confidence interval [CI] 0.62‒0.96; p = 0.020) or an inpatient visit (OR 0.70, 95% CI 0.49‒0.98; p = 0.039) than those who underwent ETT or ECHO. ETT and ECHO were not predictive of any outcome.
Conclusions:
SPECT-MPI does not result in more downstream HCRU than ETT or ECHO and is associated with a lower likelihood of repeat non-invasive CV testing and inpatient visits.
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