Cardiac testing choices by physician specialty in the CMR-IMPACT trial

Area of Science:

• Cardiology
• Clinical Medicine
• Health Services Research

Background:

• Significant heterogeneity exists in the management of patients presenting with chest pain.
• Investigating physician specialty's role in diagnostic testing for suspected acute coronary syndrome (ACS) is crucial.

Purpose of the Study:

• To examine the association between admitting physician specialty and diagnostic testing patterns.
• Specifically, to compare invasive angiography rates and protocol adherence based on physician specialty in ACS patients.

Main Methods:

• Secondary analysis of the CMR-IMPACT multicenter randomized controlled trial.
• Patients with suspected ACS were randomized to invasive angiography or non-invasive CMR stress imaging.
• Admitting physicians were categorized as interventional cardiologists (IC) or other specialists; statistical analysis used generalized estimating equations.

Main Results:

• Patients admitted by ICs underwent index angiography more frequently (65.4%) compared to those admitted by other physicians (53.1%).
• Protocol adherence for the invasive strategy was higher with ICs (85.3%) versus others (64.5%).
• For the CMR-based strategy, protocol adherence was similar between ICs (67.7%) and other physicians (66.7%).

Conclusions:

• Admitting physician specialty, particularly interventional cardiology, influences the utilization of invasive angiography in suspected ACS cases.
• This suggests specialty-driven variations in diagnostic pathways for acute coronary syndrome.