Michael Hammer1, Muhtashim Mian1, Levi Elhadad1, Mary Li1, Idan Roifman2,3,4. 1. Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada. 2. Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada. idan.roifman@sunnybrook.ca. 3. Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada. idan.roifman@sunnybrook.ca. 4. Medicine and Medical Imaging, Adjunct Scientist, Institute for Clinical Evaluative Sciences, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Room M315, Toronto, ON, M4N-3M5, Canada. idan.roifman@sunnybrook.ca.
Abstract
BACKGROUND: Appropriate use criteria (AUC) have been developed in response to growth in cardiac imaging utilization and concern regarding associated costs. Cardiac computed tomography angiography (CCTA) has emerged as an important modality in the evaluation of coronary artery disease, however its appropriate utilization in actual practice is uncertain. Our objective was to determine the appropriate utilization of CCTA in a large quaternary care institution and to compare appropriate utilization pre and post publication of the 2013 AUC guidelines. We hypothesized that the proportion of appropriate CCTA utilization will be similar to those of other comparable cardiac imaging modalities and that there would be a significant increase in appropriate use post AUC publication. METHODS: We employed a retrospective cohort study design of 2577 consecutive patients undergoing CCTA between January 1, 2012 and December 30, 2016. An appropriateness category was assigned for each CCTA. Appropriateness classifications were compared pre- and post- AUC publication via the chi-square test. RESULTS: Overall, 83.5% of CCTAs were deemed to be appropriate based on the AUC. Before the AUC publication, 75.0% of CCTAs were classified as appropriate whereas after the AUC publication, 88.0% were classified as appropriate (p < 0.001). The increase in appropriate utilization, when extrapolated to the Medicare population of the United States, was associated with potential cost savings of approximately $57 million per year. CONCLUSIONS: We report a high rate of appropriate use of CCTA and a significant increase in the proportion of CCTAs classified as appropriate after the AUC publication.
BACKGROUND: Appropriate use criteria (AUC) have been developed in response to growth in cardiac imaging utilization and concern regarding associated costs. Cardiac computed tomography angiography (CCTA) has emerged as an important modality in the evaluation of coronary artery disease, however its appropriate utilization in actual practice is uncertain. Our objective was to determine the appropriate utilization of CCTA in a large quaternary care institution and to compare appropriate utilization pre and post publication of the 2013 AUC guidelines. We hypothesized that the proportion of appropriate CCTA utilization will be similar to those of other comparable cardiac imaging modalities and that there would be a significant increase in appropriate use post AUC publication. METHODS: We employed a retrospective cohort study design of 2577 consecutive patients undergoing CCTA between January 1, 2012 and December 30, 2016. An appropriateness category was assigned for each CCTA. Appropriateness classifications were compared pre- and post- AUC publication via the chi-square test. RESULTS: Overall, 83.5% of CCTAs were deemed to be appropriate based on the AUC. Before the AUC publication, 75.0% of CCTAs were classified as appropriate whereas after the AUC publication, 88.0% were classified as appropriate (p < 0.001). The increase in appropriate utilization, when extrapolated to the Medicare population of the United States, was associated with potential cost savings of approximately $57 million per year. CONCLUSIONS: We report a high rate of appropriate use of CCTA and a significant increase in the proportion of CCTAs classified as appropriate after the AUC publication.
Entities:
Keywords:
Appropriate use criteria; Cardiac computed tomography; Coronary artery disease; Value of non-invasive testing
Authors: Meagan M Wasfy; Thomas J Brady; Suhny Abbara; Khurram Nasir; Udo Hoffmann; Ricardo C Cury; Marcelo F Di Carli; Ron Blankstein Journal: J Cardiovasc Comput Tomogr Date: 2012-01-28
Authors: Idan Roifman; Mohammad R Rezai; Harindra C Wijeysundera; Benjamin J W Chow; Graham A Wright; Jack V Tu Journal: J Cardiovasc Comput Tomogr Date: 2015-07-22
Authors: Yaron Arbel; Feng Qiu; Maria C Bennell; Peter C Austin; Idan Roifman; Mohammad R Rezai; Jack V Tu; Dennis T Ko; Harindra C Wijeysundera Journal: Am Heart J Date: 2016-02-27 Impact factor: 4.749
Authors: John A Miller; Eugenia Raichlin; Eric E Williamson; Robert B McCully; Patricia A Pellikka; David O Hodge; Todd D Miller; Raymond J Gibbons; Philip A Araoz Journal: J Am Coll Radiol Date: 2010 Impact factor: 5.532
Authors: Grace Ronan; Michael J Wolk; Steven R Bailey; John U Doherty; Pamela S Douglas; Robert C Hendel; Christopher M Kramer; James K Min; Manesh R Patel; Lisa Rosenbaum; Leslee J Shaw; Raymond F Stainback; Joseph M Allen; Ralph G Brindis; Christopher M Kramer; Leslee J Shaw; Manuel D Cerqueira; Jersey Chen; Larry S Dean; Reza Fazel; W Gregory Hundley; Dipti Itchhaporia; Paul Kligfield; Richard Lockwood; Joseph Edward Marine; Robert Benjamin McCully; Joseph V Messer; Patrick T O'Gara; Richard J Shemin; L Samuel Wann; John B Wong; Manesh R Patel; Christopher M Kramer; Steven R Bailey; Alan S Brown; John U Doherty; Pamela S Douglas; Robert C Hendel; Bruce D Lindsay; James K Min; Leslee J Shaw; Raymond F Stainback; L Samuel Wann; Michael J Wolk; Joseph M Allen Journal: J Nucl Cardiol Date: 2014-02 Impact factor: 5.952
Authors: Andrew Remfry; Howard Abrams; David M Dudzinski; Rory B Weiner; R Sacha Bhatia Journal: Cardiovasc Ultrasound Date: 2015-11-14 Impact factor: 2.062