Temporal Trends in Noninvasive and Invasive Cardiac Testing From 2010 to 2022 in the US Medicare Population

Area of Science:

• Cardiology
• Medical Imaging
• Health Services Research

Background:

• Cardiac diagnostic testing utilization is evolving amidst technological advancements and updated guidelines.
• Optimal use of various cardiac diagnostic procedures remains a subject of ongoing debate.
• Understanding long-term trends in cardiac test utilization is crucial for healthcare planning.

Purpose of the Study:

• To evaluate long-term utilization trends of diverse cardiac diagnostic tests.
• To analyze these trends within the context of Medicare Part B population from 2010 to 2022.
• To identify shifts in diagnostic modality preferences over time.

Main Methods:

• Utilized Joinpoint regression analysis for trend analysis.
• Compared annual cardiac testing volumes across different tests and provider specialties.
• Focused on data from the Medicare Part B population between 2010 and 2022.

Main Results:

• Transthoracic echocardiography remained the most utilized test, increasing from 61.5% to 67.7%.
• Single-photon emission CT myocardial perfusion imaging use decreased significantly, while positron emission tomography myocardial perfusion imaging, cardiac MRI, and coronary CT angiography showed relative increases.
• Newer tests like fractional flow reserve by CT and pyrophosphate scintigraphy demonstrated substantial growth in utilization.

Conclusions:

• Cardiac diagnostic testing in Medicare beneficiaries has shifted from invasive angiography and traditional stress tests towards cardiac CT, cardiac MRI, and PET imaging.
• Utilization of fractional flow reserve by CT and pyrophosphate scintigraphy has markedly increased.
• These evolving trends highlight the need to reassess current cardiovascular medicine training recommendations.