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Published on: August 9, 2024
Adoption of the Coronary Artery Disease-reporting and Data System: Reduced Downstream Testing and Cardiology Referral
Joshua Boster1, Robert Hull2, Michael U Williams3
1Internal Medicine, Brooke Army Medical Center, Fort Sam Houston, USA.
Insights
The Coronary Artery Disease-Reporting and Data System (CAD-RADS) template reduced downstream testing and cardiology referrals for patients with non-obstructive coronary artery disease (CAD). This standardization improves care recommendations for CAD patients.
Area of Science:
- Cardiovascular Imaging and Diagnostics
- Radiology Reporting Systems
Background:
- Standardized reporting is crucial for consistent communication of coronary CT angiography (CCTA) findings.
- The Coronary Artery Disease-Reporting and Data System (CAD-RADS) was developed to standardize maximal stenosis assessment and guide treatment recommendations.
- Evaluating the impact of CAD-RADS on downstream testing and healthcare costs is essential for clinical practice.
Purpose of the Study:
- To assess the effect of adopting the CAD-RADS reporting template on downstream testing, cardiology referrals, and associated costs.
- To compare outcomes in patients undergoing CCTA before and after CAD-RADS implementation.
Main Methods:
- A retrospective analysis of 1,796 patients undergoing CCTA before and after CAD-RADS adoption at a single center.
- Data abstracted included downstream testing, cardiology referrals, and costs, analyzed using the CMS OPPS 2018 final rule.
- Patient cohorts were compared based on CAD-RADS reporting versus non-standardized reporting (NSR).
Main Results:
- Overall downstream testing and cardiology referral rates were similar between the CAD-RADS and NSR groups.
- However, referral for downstream testing was significantly reduced in the CAD-RADS 1 & 2 (non-obstructive CAD) cohort compared to NSR (5.1% vs. 14.4%, p < 0.001).
- This reduction was partially offset by more non-diagnostic scans in the CAD-RADS group, leading to increased downstream testing (28.8% vs. 11.4%, p = 0.038) and similar median costs.
Conclusions:
- Adoption of the CAD-RADS template is associated with a reduction in downstream testing and cardiology referrals for patients with non-obstructive CAD (CAD-RADS 1 & 2).
- CAD-RADS may help optimize further diagnostic pathways for patients where further testing can typically be deferred.
- The findings support the utility of CAD-RADS in standardizing CCTA interpretation and guiding appropriate patient management.
Abstract:
Introduction The coronary artery disease-reporting and data system (CAD-RADS) was developed to standardize communication of per-patient maximal stenosis and provide treatment recommendations that may affect downstream testing. Methods Downstream testing, cardiology referral, and cost were abstracted for 1,796 consecutive patients undergoing coronary CT angiography (CCTA) before and after the adoption of the CAD-RADS reporting template at a single-center closed referral hospital system. Cost analysis was based on direct invasive and non-invasive testing utilizing the Center for Medicare & Medicaid Services (CMS) outpatient prospective payment system (OPPS) final rule for 2018. Results Baseline cardiovascular risk factors were balanced between the groups. Overall, referrals for downstream testing were similar between cohorts (10.7% vs 10.8%; p = 0.939). Referral for downstream testing was reduced in the CAD-RADS 1 & 2 cohort compared to non-obstructive coronary artery disease (CAD) by non-standardized reporting (NSR; 5.1% vs 14.4%, p < 0.001). This was offset by more non-diagnostic scans in the CAD-RADS cohort (9.7% vs 4.2%, p < 0.001), resulting in increased downstream testing (28.8% vs 11.4%, p = 0.038). Overall, cardiology referral rates by primary care providers (PCPs) were similar between the groups (12.2% vs 15.8%, p = 0.197). Cardiology referral rates were increased among patients with non-obstructive CAD in the NSR cohort compared with CAD-RADS 1 & 2 patients (20.5% vs 8.6%, p = 0.021). Referrals for invasive coronary angiography were low in both groups overall (3.5% vs 3.2%, p = 0.726). Median downstream testing costs were similar between the groups (p = 0.554). Conclusions Adoption of the CAD-RADS reporting template was associated with a reduction in downstream testing and cardiology referral rates among non-obstructive CAD (CAD-RADS 1 & 2) patients. Thus, CAD-RADS may impact downstream testing in patients in whom further testing can typically be deferred.
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