1
|
Doukky R. ASNC SPECT-MPI quality metrics: a race to the top. J Nucl Cardiol 2023; 30:911-914. [PMID: 37193923 DOI: 10.1007/s12350-023-03284-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 04/18/2023] [Indexed: 05/18/2023]
Affiliation(s)
- Rami Doukky
- Division of Cardiology, Cook County Health, 1901 W. Harrison St., Chicago, IL, 60612, USA.
- Division of Cardiology, Rush University Medical Center, Chicago, IL, USA.
| |
Collapse
|
2
|
Hage FG, Einstein AJ, Ananthasubramaniam K, Bourque JM, Case J, DePuey EG, Hendel RC, Henzlova MJ, Shah NR, Abbott BG, Al Jaroudi W, Better N, Doukky R, Duvall WL, Malhotra S, Pagnanelli R, Peix A, Reyes E, Saeed IM, Sanghani RM, Slomka PJ, Thompson RC, Veeranna V, Williams KA, Winchester DE. Quality metrics for single-photon emission computed tomography myocardial perfusion imaging: an ASNC information statement. J Nucl Cardiol 2023; 30:864-907. [PMID: 36607538 DOI: 10.1007/s12350-022-03162-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 11/17/2022] [Indexed: 01/07/2023]
Affiliation(s)
- Fadi G Hage
- Section of Cardiology, Birmingham VA Medical Center, Birmingham, AL, USA.
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, 446 GSB, 520 19Th Street South, Birmingham, AL, 35294, USA.
| | - Andrew J Einstein
- Seymour, Paul and Gloria Milstein Division of Cardiology, Department of Medicine and Department of Radiology, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, NY, USA
| | | | - Jamieson M Bourque
- Department of Medicine (Cardiology), University of Virginia Health System, Charlottesville, VA, USA
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA, USA
| | - James Case
- Cardiovascular Imaging Technologies, Kansas City, MO, USA
| | - E Gordon DePuey
- Mount Sinai Morningside Hospital, New York, NY, USA
- Bay Ridge Medical Imaging, Brooklyn, NY, USA
| | - Robert C Hendel
- Department of Medicine, Division of Cardiology, Tulane University School of Medicine, New Orleans, LA, USA
| | | | - Nishant R Shah
- Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Brian G Abbott
- Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Wael Al Jaroudi
- Division of Cardiovascular Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Nathan Better
- Department of Nuclear Medicine and Cardiology, Royal Melbourne Hospital and University of Melbourne, Melbourne, Australia
| | - Rami Doukky
- Division of Cardiology, Cook County Health and Hospitals System, Chicago, IL, USA
| | - W Lane Duvall
- Heart and Vascular Institute, Hartford Hospital, Hartford, CT, USA
| | - Saurabh Malhotra
- Division of Cardiology, Cook County Health and Hospitals System, Chicago, IL, USA
| | | | - Amalia Peix
- Nuclear Medicine Department, Institute of Cardiology and Cardiovascular Surgery, La Habana, Cuba
| | - Eliana Reyes
- Nuclear Medicine Department, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Ibrahim M Saeed
- Virginia Heart, Falls Church, VA, USA
- INOVA Heart and Vascular Institute, Falls Church, VA, USA
- University of Missouri, Kansas City, MO, USA
| | - Rupa M Sanghani
- Division of Cardiology, Department of Medicine, Rush University Medical Center, Chicago, IL, USA
| | | | - Randall C Thompson
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Vikas Veeranna
- Division of Cardiology, Department of Medicine, New England Heart and Vascular Institute, Manchester, NH, USA
| | - Kim A Williams
- Department of Medicine, University of Louisville Department of Medicine, Louisville, KY, USA
| | - David E Winchester
- Malcom Randall VA Medical Center, Gainesville, FL, USA
- Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| |
Collapse
|
3
|
Tottleben J, Howland J, Rofael M, Co MLF, Torres A, Doukky R. The prognostic and diagnostic implications of surveillance serial myocardial perfusion imaging in asymptomatic renal transplant candidates. J Nucl Cardiol 2023; 30:152-163. [PMID: 35705845 DOI: 10.1007/s12350-022-03017-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 05/12/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND The utility of serial SPECT myocardial perfusion imaging (MPI) for CAD surveillance in asymptomatic ESRD patients awaiting kidney transplantation (KT) is uncertain. METHODS AND RESULTS We retrospectively investigated 700 asymptomatic KT candidates with ≥ 2 pre-transplant SPECT-MPIs (mean interval, 20 ± 13 months). Worsening MPI was defined as total perfusion deficit increase (ΔTPD) > 5%. High clinical risk was defined as ≥ 3 AHA/ACC KT risk factors. The primary outcome was major adverse cardiac events (MACE) of cardiac death or myocardial infarction. The initial MPI was normal in 462 (66%) subjects. On repeat MPI, ΔTPD > 5% was observed in 82 (12%) subjects, and the incidence increased with increasing time gap between MPIs (P = .006). During a mean follow-up of 16 ± 8 months, there were 119 (17%) MACEs. In the entire cohort, ΔTPD > 5% was not significantly associated with MACE (HR = 1.38; P = .210). ΔTPD > 5% was associated with increased MACE rate among patients with normal initial MPI (HR = 2.30; P = .005), but not among those with abnormal initial MPI (P = .260). There was a significant interaction between ΔTPD > 5% and initial MPI normalcy status in predicting MACE (interaction P = .018), such that the predictive value of ΔTPD is dependent on the initial MPI normalcy. Among subjects with normal initial MPI, ΔTPD > 5% was significantly associated with MACE only if the sum of KT risk factors was ≥ 3 (HR = 2.26; P = .016). Among 123 patients who underwent coronary angiography, ΔTPD > 5% was associated with a higher prevalence of obstructive CAD when the initial MPI was normal and the sum of KT risk factors was ≥ 3. CONCLUSION Among patients with ESRD waitlisted for KT, new/worsening MPI abnormalities are expected. On serial surveillance, ΔTPD > 5% is associated with MACE and obstructive CAD among those with a normal initial MPI and ≥ 3 AHA/ACC KT risk factors.
Collapse
Affiliation(s)
- Jonathan Tottleben
- Division of Cardiology, Cook County Health, 1901 W. Harrison Street, Chicago, IL, 60612, USA
- Division of Cardiology, Rush University Medical Center, Chicago, IL, USA
| | - Julia Howland
- School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | - Michael Rofael
- Division of Cardiology, Cook County Health, 1901 W. Harrison Street, Chicago, IL, 60612, USA
| | | | - Andrea Torres
- Division of Cardiology, Cook County Health, 1901 W. Harrison Street, Chicago, IL, 60612, USA
| | - Rami Doukky
- Division of Cardiology, Cook County Health, 1901 W. Harrison Street, Chicago, IL, 60612, USA.
- Division of Cardiology, Rush University Medical Center, Chicago, IL, USA.
| |
Collapse
|
4
|
Shpilsky D, Harinstein ME. Evaluation of the impact of laboratory accreditation on downstream outcomes. J Nucl Cardiol 2021; 28:2962-2964. [PMID: 32715417 DOI: 10.1007/s12350-020-02292-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 07/13/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Daniel Shpilsky
- Heart and Vascular Institute, University of Pittsburgh Medical Center, South Tower 3F, E352.2, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Matthew E Harinstein
- Heart and Vascular Institute, University of Pittsburgh Medical Center, South Tower 3F, E352.2, 200 Lothrop Street, Pittsburgh, PA, 15213, USA.
| |
Collapse
|
5
|
Kattoor AJ, Kolkailah AA, Iskander F, Iskander M, Diep L, Khan R, Doukky R. The prognostic value of regadenoson SPECT myocardial perfusion imaging: The largest cohort to date. J Nucl Cardiol 2021; 28:2799-2807. [PMID: 32383079 DOI: 10.1007/s12350-020-02135-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 04/06/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND Data on the prognostic value of regadenoson SPECT myocardial perfusion imaging (MPI) is limited and based on small cohorts. METHODS AND RESULTS We conducted a single-center, retrospective cohort study of 10,275 consecutive patients who underwent regadenoson SPECT-MPI. Among the study subjects, 28.7% had abnormal MPI and 25.5% had myocardial ischemia. Patients were followed for a mean of 2.4 ± 2.2 years for major adverse cardiac events (MACE), defined as cardiac death or myocardial infarction. There was a significant stepwise increase in MACE with an increasing burden of perfusion abnormality (P < .001) and myocardial ischemia (P < .001). Abnormal MPI (adjusted HR 1.52; 95% CI 1.21 to 1.91) and myocardial ischemia (adjusted HR 1.53; 95% CI 1.25 to 1.89) were associated with MACE, independent of and incremental to clinical covariates and left ventricular ejection fraction (LVEF). Moreover, post-stress LVEF, LVEF reserve, and left ventricular end-diastolic volume added significant prognostic information. Transient ischemic dilation ≥ 1.31 did not provide incremental prognostic value (adjusted HR 1.02; P = .906). CONCLUSION In the largest cohort to date, we demonstrated that the presence and severity of perfusion abnormality and myocardial ischemia on regadenoson stress SPECT-MPI are associated with an independent increase in MACE.
Collapse
Affiliation(s)
- Ajoe John Kattoor
- Division of Cardiology, Cook County Health, 1901 W. Harrison St., Chicago, IL, 60612, USA
| | | | - Fady Iskander
- Division of Cardiology, Cook County Health, 1901 W. Harrison St., Chicago, IL, 60612, USA
| | - Mina Iskander
- Division of Cardiology, Cook County Health, 1901 W. Harrison St., Chicago, IL, 60612, USA
| | - Lisa Diep
- Health Research and Solutions Unit, Cook County Health, Chicago, IL, USA
| | - Rozi Khan
- Division of Cardiology, Rush University Medical Center, Chicago, IL, USA
- Department of Medicine, Medstar Union Memorial Hospital, Baltimore, MD, USA
| | - Rami Doukky
- Division of Cardiology, Cook County Health, 1901 W. Harrison St., Chicago, IL, 60612, USA.
- Department of Medicine, Cook County Health, Chicago, IL, USA.
- Division of Cardiology, Rush University Medical Center, Chicago, IL, USA.
| |
Collapse
|
6
|
Shah NR, Winchester DE, Freeman AM. Using a sledgehammer to crack a nut: The burdensome appropriate use criteria program. J Nucl Cardiol 2021; 28:1998-2000. [PMID: 31832884 DOI: 10.1007/s12350-019-01978-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 11/25/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Nishant R Shah
- Division of Cardiology, Department of Medicine, Brown University Alpert Medical School, Providence, RI, USA
| | - David E Winchester
- Cardiology Section, Malcom Randall VAMC, Department of Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Andrew M Freeman
- Division of Cardiology, Department of Medicine, National Jewish Health, 1400 Jackson St. J317, Denver, CO, 80206, USA.
| |
Collapse
|
7
|
Schwartz C, Winchester DE. Discrepancy between patient-reported and clinician-documented symptoms for myocardial perfusion imaging: initial findings from a prospective registry. Int J Qual Health Care 2021; 33:6258102. [PMID: 33913488 DOI: 10.1093/intqhc/mzab076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 04/05/2021] [Accepted: 04/28/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Occasionally, the symptoms reported by patients disagree with those documented in the medical record. We designed the Patient Centered Assessment of Symptoms (PCAS) registry to measure discrepancies between patient-reported and clinician-documented symptoms. OBJECTIVE Use patient-derived symptoms data to measure discrepancies with clinical documentation. METHODS The PCAS registry captured data from a prospective cohort of patients undergoing myocardial perfusion imaging (MPI) and includes free response and structured questions to gauge symptoms. Clinician-documented symptoms were extracted from the patients' medical records. The appropriateness of testing was determined twice: once using the patient-reported symptoms and once using the clinician-documented symptoms. RESULTS A total of 90 subjects were enrolled, among whom diabetes (36.7%), prior coronary disease (28.9%), hypertension (80.0%) and hyperlipidemia (85.6%) were common. Percentage of patient-reported symptoms compared to clinician-documented symptoms and agreement were as follows: chest pain (patient 29.0%, clinician 36.6%, moderate [kappa = 0.54]), chest pressure (patient 18.3%, clinician 10.8%, fair [kappa = 0.27]), dyspnea (patient 41.0%, clinician 36.6%, fair [kappa = 0.28]), onset with exertion (patient 61.7%, clinician 59.6%, slight [kappa = 0.17]), symptoms same as prior coronary artery disease (patient 46.2%, clinician 15.3%, slight [kappa = 0.01]). As a result of these inconsistencies, appropriateness ratings were different for 13.3% (n = 12) subjects. CONCLUSION In this prospective registry of patients undergoing MPI, we observed substantial disagreements between patient-reported and clinician-documented symptoms. Disagreement resulted in a considerable proportion of MPI appropriateness ratings also being incongruous.
Collapse
Affiliation(s)
- Cody Schwartz
- Department of Medicine, University of Florida, 1600 SW Archer Road Gainesville, Gainesville, FL 32610, USA
| | - David E Winchester
- Medical Service, Malcom Randall VA Medical Center, 1601 SW Archer Road, Box 111-D, Gainesville, FL 32608, USA.,Division of Cardiology, University of Florida, 1600 SW Archer Road Gainesville, Gainesville, FL 32610, USA
| |
Collapse
|
8
|
Winchester DE, Merritt J, Waheed N, Norton H, Manja V, Shah NR, Helfrich CD. Implementation of appropriate use criteria for cardiology tests and procedures: a systematic review and meta-analysis. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2021; 7:34-41. [PMID: 32232436 DOI: 10.1093/ehjqcco/qcaa029] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/23/2020] [Accepted: 03/26/2020] [Indexed: 11/13/2022]
Abstract
AIMS The American College of Cardiology appropriate use criteria (AUC) provide clinicians with evidence-informed recommendations for cardiac care. Adopting AUC into clinical workflows may present challenges, and there may be specific implementation strategies that are effective in promoting effective use of AUC. We sought to assess the effect of implementing AUC in clinical practice. METHODS AND RESULTS We conducted a meta-analysis of studies found through a systematic search of the MEDLINE, Web of Science, Cochrane, or CINAHL databases. Peer-reviewed manuscripts published after 2005 that reported on the implementation of AUC for a cardiovascular test or procedure were included. The main outcome was to determine if AUC implementation was associated with a reduction in inappropriate/rarely appropriate care. Of the 18 included studies, the majority used pre/post-cohort designs; few (n = 3) were randomized trials. Most studies used multiple strategies (n = 12, 66.7%). Education was the most common individual intervention strategy (n = 13, 72.2%), followed by audit and feedback (n = 8, 44.4%) and computerized physician order entry (n = 6, 33.3%). No studies reported on formal use of stakeholder engagement or 'nudges'. In meta-analysis, AUC implementation was associated with a reduction in inappropriate/rarely appropriate care (odds ratio 0.62, 95% confidence interval 0.49-0.78). Funnel plot suggests the possibility of publication bias. CONCLUSION We found most published efforts to implement AUC observed reductions in inappropriate/rarely appropriate care. Studies rarely explored how or why the implementation strategy was effective. Because interventions were infrequently tested in isolation, it is difficult to make observations about their effectiveness as stand-alone strategies. STUDY REGISTRATION PROSPERO 2018 CRD42018091602. Available from https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42018091602.
Collapse
Affiliation(s)
- David E Winchester
- Cardiology Section, Malcom Randall VAMC, 1601 SW Archer Rd 111-D, Gainesville, FL, USA.,Division of Cardiovascular Medicine, University of Florida College of Medicine, 1600 SW Archer Rd, Gainesville, FL 32610, USA
| | - Justin Merritt
- Division of Cardiovascular Medicine, University of Florida College of Medicine, 1600 SW Archer Rd, Gainesville, FL 32610, USA
| | - Nida Waheed
- Department of Internal Medicine, University of Florida College of Medicine, 1600 SW Archer Rd, Gainesville, FL 32610, USA
| | - Hannah Norton
- University of Florida College of Medicine, Health Science Center Library, 1600 SW Archer Rd, Gainesville, FL 32610, USA
| | - Veena Manja
- Department of Surgery, University of California Davis, 2315 Stockton Blvd, Sacramento, CA 95817, USA.,VA Northern California Health Care System, 10535 Hospital Way, Mather, CA 95655, USA
| | - Nishant R Shah
- Department of Medicine, Providence VA Medical Center, Brown University Warren Alpert Medical School, 830 Chalkstone Ave, Providence, RI 02908, USA.,Department of Health Services, Policy & Practice, Brown University School of Public Health, 121 S Main St, Providence, RI 02903, USA
| | - Christian D Helfrich
- Seattle-Denver Center for Innovation in Veteran-Centered and Value-Driven Care, 1660 S. Columbian Way Mailstop S-152 Seattle, WA 98108, USA
| |
Collapse
|
9
|
Anderson JL. Making better use of appropriate use criteria. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2021; 7:3-5. [PMID: 32421803 DOI: 10.1093/ehjqcco/qcaa044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Jeffrey L Anderson
- Intermountain Medical Center Heart Institute, 5121 So. Cottonwood Street, Building 4, 6th floor, Murray, UT 84107, USA
- Department of Internal Medicine, Division of Cardiology, University of Utah School of Medicine, Salt Lake City, UT, USA
| |
Collapse
|
10
|
Prevalence of abnormal SPECT myocardial perfusion imaging during the COVID-19 pandemic. Eur J Nucl Med Mol Imaging 2021; 48:2447-2454. [PMID: 33416952 PMCID: PMC7791164 DOI: 10.1007/s00259-020-05123-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 11/15/2020] [Indexed: 02/06/2023]
Abstract
Purpose The aim of this study is to evaluate the rate of abnormal myocardial perfusion imaging (MPI) studies at a single medical center during the COVID-19 pandemic compared to prior to the pandemic. Methods We retrospectively studied stress single-photon emission computed tomography (SPECT)-MPI studies performed during the peak of COVID-19 restrictions at the University of Alabama Medical Center in comparison to the same time period in 2019. Results SPECT-MPI volume was reduced from 553 per month in 2019 to 105 per month in 2020. The proportion of abnormal SPECT-MPI for the 2020 cohort (61 ± 13 years, 48% men, 41% black) was not different from the 2019 cohort (62 ± 12 years, 48% men, 42% black) (31% vs. 27%, p = 0.4). Similar proportion of patients in the 2 cohorts had abnormal myocardial perfusion, moderate-large perfusion defects, myocardial ischemia, myocardial scar, and abnormal left ventricular ejection fraction. The proportion of abnormal SPECT-MPIs was not different based on whether patients were evaluated face-to-face or by telemedicine (28% vs. 27%, p > 0.9) but was higher for cardiology providers (40% vs. 20%, p < 0.001). Conclusions There was a significant reduction in the number of SPECT-MPI studies performed during the peak restrictions from the pandemic. Despite this restriction, the rate of abnormal studies remained stable. Our study suggests that it remains difficult to predict which patients will have abnormal SPECT-MPI even when providers and stress laboratories are forced to prioritize the performance of studies to high-yield patients.
Collapse
|
11
|
Amadio JM, Bouck Z, Sivaswamy A, Chu C, Austin PC, Dudzinski D, Nesbitt GC, Edwards J, Yared K, Wong B, Hansen M, Weinerman A, Thavendiranathan P, Johri AM, Rakowski H, Picard MH, Weiner RB, Bhatia RS. Impact of Appropriate Use Criteria for Transthoracic Echocardiography in Valvular Heart Disease on Clinical Outcomes. J Am Soc Echocardiogr 2020; 33:1481-1489. [PMID: 32893052 DOI: 10.1016/j.echo.2020.06.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 06/17/2020] [Accepted: 06/26/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND The association between appropriate use criteria for transthoracic echocardiography (TTE) and clinical outcomes is unknown for patients with valvular heart disease (VHD). The aim of this study was to identify the association of TTE appropriateness with downstream cardiac tests and clinical outcomes in patients with VHD over 365 days. METHODS A subset of 2,297 patients with VHD across six Ontario academic hospitals was selected from the Echo WISELY (Will Inappropriate Scenarios for Echocardiography Lessen Significantly) trial and linked to administrative databases. Each patient's index TTE was classified as "rarely appropriate" (rA) versus "appropriate" (comprising "appropriate" and "may be appropriate" TTE according to the 2011 appropriate use criteria). Overall, 431 of 452 patients with rA TTE were matched 1:1 with patients with appropriate TTE using propensity scores to account for measured confounding. RESULTS Matched patients with rA TTE were less likely to undergo repeat TTE (relative risk, 0.46; 95% CI, 0.33-0.66) or cardiac catheterization (relative risk, 0.27; 95% CI, 0.16-0.47) at 90 days compared with patients with appropriate TTE. rA TTE was significantly associated with a decreased hazard of aortic valve intervention (hazard ratio, 0.40; 95% CI, 0.14-0.42), all-cause hospitalization (hazard ratio, 0.44; 95% CI, 0.34-0.57), and death (hazard ratio, 0.31; 95% CI, 0.15-0.66) over 365 days of follow-up. CONCLUSIONS Patients with appropriate TTE for VHD were more likely to undergo subsequent cardiac testing within 90 days and valve intervention within 1 year than those with a rA TTE. The 2011 appropriate use criteria for TTE have important clinical implications for outcomes in patient with VHD.
Collapse
Affiliation(s)
- Jennifer M Amadio
- Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Zachary Bouck
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
| | | | - Cherry Chu
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
| | | | - David Dudzinski
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Jeremy Edwards
- Division of Cardiology, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Kibar Yared
- The Scarborough Hospital, Toronto, Ontario, Canada
| | - Brian Wong
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Mark Hansen
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | | | - Amer M Johri
- Queen's University, Kingston Health Sciences Centre, Kingston, Ontario, Canada
| | - Harry Rakowski
- Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Michael H Picard
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Rory B Weiner
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - R Sacha Bhatia
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada.
| |
Collapse
|
12
|
Estimates of radiation exposure and subsequent risk of malignancy due to cardiac imaging in the emergency department for evaluation of chest pain: a cohort study. Coron Artery Dis 2020; 30:626-628. [PMID: 31577617 DOI: 10.1097/mca.0000000000000806] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
13
|
Al Badarin FJ, Chan PS, Spertus JA, Thompson RC, Patel KK, Kennedy KF, Bateman TM. Temporal trends in test utilization and prevalence of ischaemia with positron emission tomography myocardial perfusion imaging. Eur Heart J Cardiovasc Imaging 2020; 21:318-325. [PMID: 31292618 DOI: 10.1093/ehjci/jez159] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 01/30/2019] [Accepted: 05/28/2019] [Indexed: 01/14/2023] Open
Abstract
AIMS To examine whether test utilization and prevalence of ischemia with positron emission tomography (PET) myocardial perfusion imaging (MPI) follow the previously described trends with single photon computed tomography (SPECT). METHODS AND RESULTS MPI studies performed between January 2003 and December 2017 were identified. Number of PET and SPECT MPI studies performed per year was determined. Trends in the proportion of studies showing any ischaemia (>0%) with both modalities were compared before and after adjusting for baseline differences in patient characteristics using propensity scores. Interaction between imaging modality and year of testing was examined using modified Poisson regression. A total of 156 244 MPI studies were performed (30% PET and 70% SPECT). Between 2003 and 2017, the number of PET studies increased from 18 to 61 studies/1000 patient encounters, while SPECT volumes declined from 169 to 34/1000 patient encounters (P < 0.001 for within-group comparisons). The prevalence of any ischaemia in SPECT-tested patients declined from 53.9% to 28.3% between 2003 and 2017, whereas ischaemia prevalence in PET-tested patients declined from 57.2% to 38.2% (P < 0.001 for within-modality comparisons), with more PET studies showing ischaemia compared to SPECT [relative risk (RR) 1.44, 95% confidence interval (CI) 1.42-1.47; P < 0.001]. After propensity score matching of 26 066 patients tested with SPECT with 26 066 patients tested with PET, the between-modality difference in ischaemia prevalence was significantly attenuated, with a slightly higher overall likelihood of detecting ischaemia with PET compared to SPECT (RR 1.08, 95% CI 1.05-1.11; P < 0.001). CONCLUSIONS Utilization of PET MPI at a large-volume referral centre increased significantly between 2003 and 2017. Despite a significant decrease in the prevalence of ischaemia with SPECT and PET during the same period, the decline was less with PET, perhaps related to baseline risk of tested patients.
Collapse
Affiliation(s)
- Firas J Al Badarin
- School of Medicine, University of Missouri-Kansas City, 2411 Holmes St, Kansas City, MO 64108, USA.,Department of Cardiovascular Research, Saint Luke's Mid America Heart Institute, 4401 Wornall Rd, Kansas City, MO 64111, USA
| | - Paul S Chan
- School of Medicine, University of Missouri-Kansas City, 2411 Holmes St, Kansas City, MO 64108, USA.,Department of Cardiovascular Research, Saint Luke's Mid America Heart Institute, 4401 Wornall Rd, Kansas City, MO 64111, USA
| | - John A Spertus
- School of Medicine, University of Missouri-Kansas City, 2411 Holmes St, Kansas City, MO 64108, USA.,Department of Cardiovascular Research, Saint Luke's Mid America Heart Institute, 4401 Wornall Rd, Kansas City, MO 64111, USA
| | - Randall C Thompson
- School of Medicine, University of Missouri-Kansas City, 2411 Holmes St, Kansas City, MO 64108, USA.,Department of Cardiovascular Research, Saint Luke's Mid America Heart Institute, 4401 Wornall Rd, Kansas City, MO 64111, USA
| | - Krishna K Patel
- School of Medicine, University of Missouri-Kansas City, 2411 Holmes St, Kansas City, MO 64108, USA.,Department of Cardiovascular Research, Saint Luke's Mid America Heart Institute, 4401 Wornall Rd, Kansas City, MO 64111, USA
| | - Kevin F Kennedy
- Department of Cardiovascular Research, Saint Luke's Mid America Heart Institute, 4401 Wornall Rd, Kansas City, MO 64111, USA
| | - Timothy M Bateman
- School of Medicine, University of Missouri-Kansas City, 2411 Holmes St, Kansas City, MO 64108, USA.,Department of Cardiovascular Research, Saint Luke's Mid America Heart Institute, 4401 Wornall Rd, Kansas City, MO 64111, USA
| |
Collapse
|
14
|
Doukky R. PAMA implementation: The road ahead. J Nucl Cardiol 2019; 26:1789-1791. [PMID: 31686325 DOI: 10.1007/s12350-019-01942-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 10/21/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Rami Doukky
- Division of Cardiology, Cook County Health, 1901 W. Harrison St., Chicago, IL, 60612, USA.
- Division of Cardiology, Rush University Medical Center, Chicago, IL, USA.
| |
Collapse
|
15
|
Abelhad NI, Kiser KJ, Hughes A, Hust MA, Sayan EG, Prakash SK. Prevalence and clinical characteristics of inappropriate myocardial perfusion imaging tests at a community hospital. BMJ Open Qual 2019; 8:e000487. [PMID: 31363501 PMCID: PMC6629399 DOI: 10.1136/bmjoq-2018-000487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 04/04/2019] [Accepted: 04/27/2019] [Indexed: 11/04/2022] Open
Affiliation(s)
- Nadia Isabel Abelhad
- Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Kendall J Kiser
- Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Andres Hughes
- Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Michael A Hust
- Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Enrique Garcia Sayan
- Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Siddharth K Prakash
- Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, Texas, USA
| |
Collapse
|
16
|
Hendel RC, Lindsay BD, Allen JM, Brindis RG, Patel MR, White L, Winchester DE, Wolk MJ. ACC Appropriate Use Criteria Methodology: 2018 Update: A Report of the American College of Cardiology Appropriate Use Criteria Task Force. J Am Coll Cardiol 2019; 71:935-948. [PMID: 29471942 DOI: 10.1016/j.jacc.2018.01.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
17
|
Phillips LM, Shaw LJ. More or less appropriate: The new rule of law for cardiac imaging. J Nucl Cardiol 2019; 26:831-832. [PMID: 29435860 DOI: 10.1007/s12350-018-1214-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 01/22/2018] [Indexed: 10/18/2022]
Affiliation(s)
| | - Leslee J Shaw
- Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, 1462 Clifton Rd NE, Room 529, Atlanta, GA, 30324, USA.
| |
Collapse
|
18
|
Bagrova A, Alsamarah AY, Winchester DE. Comparing two methods for determining appropriateness of myocardial perfusion imaging: Criteria from the American College of Cardiology Foundation and the American College of Radiology. J Nucl Cardiol 2019; 26:826-830. [PMID: 28660600 DOI: 10.1007/s12350-017-0965-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 06/14/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Appropriate use criteria (AUC) developed by the American College of Cardiology Foundation and the appropriateness criteria (AC) developed by the American College of Radiology (ACR) are two existing methods of rating appropriateness of myocardial perfusion imaging (MPI). One study found poor agreement of ratings between the two methods. However, using the most contemporary AUC from 2013, it is unknown if poor agreement still exists. METHODS Retrospective cohort investigation comparing patients undergoing nuclear MPI between June 2011 and September 2014. The appropriateness category was determined based on the 2013 AUC (Appropriate, may be appropriate, rarely appropriate) and the 2010 ACR AC (usually appropriate, maybe appropriate, usually not appropriate). The primary outcome was the degree of the agreement between the two methods. RESULTS The kappa coefficient between ACR AC and AUC was 0.32, P < 0.0001, indicating poor agreement; 40 (8%) patients were classified by the AUC but could not be classified by the ACR AC. CONCLUSION The two methods for rating the appropriateness of MPI have poor agreement; a potential for disagreement between providers and payers if only one method is used.
Collapse
Affiliation(s)
| | - Ali Y Alsamarah
- College of Medicine, University of Florida, Gainesville, FL, USA.
- Cardiovascular Medicine Department, Boston Medical Center, 88 East Newton Pavilion, Boston, MA, 02218, USA.
| | - David E Winchester
- College of Medicine, University of Florida, Gainesville, FL, USA
- Malcom Randall Veterans Affairs Medical Center, Gainesville, FL, USA
| |
Collapse
|
19
|
Winchester DE, Beyth R. Quality Improvement in Cardiovascular Imaging. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2019. [DOI: 10.15212/cvia.2019.0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
20
|
Shaw LJ. What's accepted is not always appropriate! J Nucl Cardiol 2018; 25:2056-2057. [PMID: 28770458 DOI: 10.1007/s12350-017-1007-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 07/18/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Leslee J Shaw
- Emory University School of Medicine, Atlanta, GA, USA.
| |
Collapse
|
21
|
Tilkemeier PL, Bourque J, Doukky R, Sanghani R, Weinberg RL. ASNC imaging guidelines for nuclear cardiology procedures : Standardized reporting of nuclear cardiology procedures. J Nucl Cardiol 2017; 24:2064-2128. [PMID: 28916938 DOI: 10.1007/s12350-017-1057-y] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 07/31/2017] [Indexed: 02/06/2023]
Affiliation(s)
| | - Jamieson Bourque
- Division of Cardiology, University of Virginia, Charlottesville, VA, USA
| | - Rami Doukky
- Division of Cardiology, Cook County Health and Hospitals System, Chicago, IL, USA
- Division of Cardiology, Rush University Medical Center, Chicago, IL, USA
| | - Rupa Sanghani
- Division of Cardiology, Rush University Medical Center, Chicago, IL, USA
| | - Richard L Weinberg
- Division of Cardiology, University of Michigan Health System, Ann Arbor, MI, USA
| |
Collapse
|
22
|
Hage FG, AlJaroudi WA. Review of cardiovascular imaging in the journal of nuclear cardiology in 2016: Part 2 of 2-myocardial perfusion imaging. J Nucl Cardiol 2017; 24:1190-1199. [PMID: 28386817 DOI: 10.1007/s12350-017-0875-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 03/22/2017] [Indexed: 12/20/2022]
Abstract
In 2016, the Journal of Nuclear Cardiology published many high-quality articles. Similar to previous years, we will summarize here a selection of the articles that were published in the Journal in 2016 to provide a concise review of the main advancements that have recently occurred in the field. In the first article of this two-part series we focused on publications dealing with positron emission tomography, computed tomography, and magnetic resonance. This review will place emphasis on myocardial perfusion imaging using single-photon emission-computed tomography summarizing advances in the field including in diagnosis, prognosis, and appropriate use.
Collapse
Affiliation(s)
- Fadi G Hage
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
- Section of Cardiology, Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA.
| | - Wael A AlJaroudi
- Division of Cardiovascular Medicine, Cardiovascular Imaging, Clemenceau Medical Center, P.O. Box 11-2555, Beirut, Lebanon
| |
Collapse
|
23
|
Comparison of the Appropriateness of Myocardial Perfusion Imaging in Men Versus Women. Am J Cardiol 2017; 120:191-195. [PMID: 28545628 DOI: 10.1016/j.amjcard.2017.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 04/04/2017] [Accepted: 04/04/2017] [Indexed: 11/23/2022]
Abstract
After a decade of appropriate use criteria publication, the degree and predictors of inappropriate use in women compared with men are not known. We conducted a retrospective cohort investigation comparing appropriateness categories (appropriate, maybe appropriate, and rarely appropriate) and cardiovascular outcomes in patients undergoing nuclear myocardial perfusion imaging (MPI) between June 2011 and September 2014 in predominantly inpatient setting. Of 1,475 cases reviewed, 747 (50.6%) were women, and they were more likely to have rarely appropriate use 118 (15.8%) than men 62 (8.5%), p <0.01, but they were less likely to have an abnormal MPI 102 (13.6%) than men 183 (25.6%), p <0.01. Subsequent angiography and revascularization rates were similar in women 38 (37.2%) and 5 (4.9%) and men 52 (28.4%) and 16 (8.7%), p = 0.12, p = 0.23, respectively. After median follow-up of 6 months, myocardial infarction rates were similar in women 3 (2.9%) and men 7 (3.8%), p = 0.67. Death rates were similar in women 8 (7.8%) and men 18 (9.8%), p = 0.57. The most common clinical scenario designated as rarely appropriate was in those with low pretest probability of coronary artery disease, who have interpretable electrocardiogram and are able to exercise in women 58 (49.1%) and men 21 (33.8%). In conclusion, based on the most contemporary appropriate use criteria publication, rarely appropriate use of MPI remains higher in women than that in men. This phenomenon was mostly observed in low-risk patients who can exercise.
Collapse
|
24
|
Kline KP, Plumb J, Nguyen L, Shaw LJ, Beyth RJ, Huo T, Winchester DE. Patient and Provider Attitudes on Appropriate Use Criteria for Myocardial Perfusion Imaging. JACC Cardiovasc Imaging 2017; 10:824-825. [DOI: 10.1016/j.jcmg.2016.08.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 08/16/2016] [Accepted: 08/16/2016] [Indexed: 12/01/2022]
|
25
|
Bagrova A, Alsamarah AY, Winchester DE. Comparing two methods for determining appropriateness of myocardial perfusion imaging: Criteria from the American College of Cardiology Foundation and the American College of Radiology. JOURNAL OF NUCLEAR CARDIOLOGY : OFFICIAL PUBLICATION OF THE AMERICAN SOCIETY OF NUCLEAR CARDIOLOGY 2017. [PMID: 28660600 DOI: 10.1007/s12350-017-0965–1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Appropriate use criteria (AUC) developed by the American College of Cardiology Foundation and the appropriateness criteria (AC) developed by the American College of Radiology (ACR) are two existing methods of rating appropriateness of myocardial perfusion imaging (MPI). One study found poor agreement of ratings between the two methods. However, using the most contemporary AUC from 2013, it is unknown if poor agreement still exists. METHODS Retrospective cohort investigation comparing patients undergoing nuclear MPI between June 2011 and September 2014. The appropriateness category was determined based on the 2013 AUC (Appropriate, may be appropriate, rarely appropriate) and the 2010 ACR AC (usually appropriate, maybe appropriate, usually not appropriate). The primary outcome was the degree of the agreement between the two methods. RESULTS The kappa coefficient between ACR AC and AUC was 0.32, P < 0.0001, indicating poor agreement; 40 (8%) patients were classified by the AUC but could not be classified by the ACR AC. CONCLUSION The two methods for rating the appropriateness of MPI have poor agreement; a potential for disagreement between providers and payers if only one method is used.
Collapse
Affiliation(s)
| | - Ali Y Alsamarah
- College of Medicine, University of Florida, Gainesville, FL, USA. .,Cardiovascular Medicine Department, Boston Medical Center, 88 East Newton Pavilion, Boston, MA, 02218, USA.
| | - David E Winchester
- College of Medicine, University of Florida, Gainesville, FL, USA.,Malcom Randall Veterans Affairs Medical Center, Gainesville, FL, USA
| |
Collapse
|
26
|
Winchester DE, Schmalfuss C, Helfrich CD, Beyth RJ. A specialty-specific, multimodality educational quality improvement initiative to deimplement rarely appropriate myocardial perfusion imaging. Open Heart 2017; 4:e000589. [PMID: 28674630 PMCID: PMC5471866 DOI: 10.1136/openhrt-2017-000589] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 04/06/2017] [Accepted: 04/11/2017] [Indexed: 01/03/2023] Open
Abstract
Objective Investigations of Appropriate Use Criteria (AUC) education have shown a mixed effect on changing provider behaviour. At our facility, rarely appropriate myocardial perfusion imaging (MPI) differs by specialty; awareness of AUC is low. Our objective is to investigate if specialty-specific, multimodality education could reduce rarely appropriate MPI. Methods We designed education focused on the rarely appropriate MPI ordered most often by each specialty. We tracked appropriateness of MPI in three cohorts: pre, post (immediately after) and late-post (4 months after) intervention. Results A total of 889 MPI were evaluated (n=287 pre, n=313 post, n=289 late-post), 95.3% were men. Chest pain was the most common symptom (n=530, 59.6%), while 14.1% (n=125) had no symptoms. Rarely appropriate testing decreased from 4.9% to 1.3% and remained at 1.4% in the late-post cohort (p<0.0001). In logistic regression, lack of symptoms (OR 31.3, 95% CI 10.3 to 94.8, p≤0.0001) and being in the post or late-post cohorts (OR 0.27, 95% CI 0.11 to 0.68, p=0.006) were associated with rarely appropriate MPI. Preoperative MPI in patients with good exercise capacity was a common rarely appropriate indication. Ischaemia was not observed among patients with rarely appropriate indication for MPI. Conclusions In certain clinical settings, education may be an effective approach for deimplementing rarely appropriate MPI. The effect of education may be enhanced when focused on improving patient care, delivered by a peer, and needs assessment indicates low awareness of guidelines. Lack of symptoms and preoperative MPI continue to be the predominant rarely appropriate MPI ordered.
Collapse
Affiliation(s)
- David E Winchester
- Cardiology Section, Medical Service, Malcom Randall VA Medical Center, Gainesville, Florida, USA.,Division of Cardiovascular Medicine, Department of Medicine, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Carsten Schmalfuss
- Cardiology Section, Medical Service, Malcom Randall VA Medical Center, Gainesville, Florida, USA.,Division of Cardiovascular Medicine, Department of Medicine, College of Medicine, University of Florida, Gainesville, Florida, USA
| | | | - Rebecca J Beyth
- Geriatric Research Education and Clinical Centers (GRECC), Malcom Randall VA Medical Center, Gainesville, Florida, USA.,Division of General Internal Medicine, Department of Medicine, College of Medicine, University of Florida, Gainesville, Florida, USA
| |
Collapse
|
27
|
Winchester DE, Baxter D, Markham MJ, Beyth RJ. Quality of Social Media and Web-Based Information Regarding Inappropriate Nuclear Cardiac Stress Testing and the Choosing Wisely Campaign: A Cross-Sectional Study. Interact J Med Res 2017; 6:e6. [PMID: 28473305 PMCID: PMC5438452 DOI: 10.2196/ijmr.7210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 03/13/2017] [Accepted: 03/30/2017] [Indexed: 11/13/2022] Open
Abstract
Background The World Wide Web and social media provide the public with access to medical information unlike any other time in human history. However, the quality of content related to cardiac stress testing is not well understood. Objective The aim of our study was to evaluate the quality of content on the Internet relating to the use of cardiac nuclear stress testing and the Choosing Wisely campaign. Methods We searched the World Wide Web, Google Video (including YouTube), and Twitter for information relating to these two topics. Searches were performed using English language terms from a computer in the United States not logged into any personal user accounts. Search results were reviewed for discussion of specific topics including radiation risk, accuracy of testing, alternative testing options, and discouragement of inappropriate test use. Results We evaluated a total of 348 items of content from our searches. Relevant search results for Choosing Wisely were fewer than for other search terms (45 vs 303). We did not find any content which encouraged inappropriate testing (ie, screening in low risk individuals or testing prior to low risk operations). Content related to Choosing Wisely was more likely to discourage inappropriate testing than search results for other terms (29/45, 64% vs 12/303, 4.0%, odds ratio 43.95, 95% CI 17.6-112.2, P<.001). Conclusions The Internet content on nuclear stress tests consistently discouraged inappropriate testing. The Choosing Wisely content was more likely to discourage inappropriate testing, less relevant content was available. Generating authoritative content on the Internet relating to judicious use of medical interventions may be an important role for the Choosing Wisely campaign.
Collapse
Affiliation(s)
- David E Winchester
- Cardiology Section, Medical Service, Malcom Randall VA Medical Center, Gainesville, FL, United States.,Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, FL, United States
| | - Diana Baxter
- College of Medicine, University of Florida, Gainesville, FL, United States
| | - Merry J Markham
- Division of Hematology & Oncology, Department of Medicine, University of Florida, Gainesville, FL, United States
| | - Rebecca J Beyth
- Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, United States.,Geriatric Research Education and Clinical Centers, Malcom Randall VA Medical Center, Gainesville, FL, United States
| |
Collapse
|
28
|
Appropriate Use of Cardiac Stress Testing with Imaging: A Systematic Review and Meta-Analysis. PLoS One 2016; 11:e0161153. [PMID: 27536775 PMCID: PMC4990235 DOI: 10.1371/journal.pone.0161153] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 07/28/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Appropriate use criteria (AUC) for cardiac stress tests address concerns about utilization growth and patient safety. We systematically reviewed studies of appropriateness, including within physician specialties; evaluated trends over time and in response to AUC updates; and characterized leading indications for inappropriate/rarely appropriate testing. METHODS We searched PubMed (2005-2015) for English-language articles reporting stress echocardiography or myocardial perfusion imaging (MPI) appropriateness. Data were pooled using random-effects meta-analysis and meta-regression. RESULTS Thirty-four publications of 41,578 patients were included, primarily from academic centers. Stress echocardiography appropriate testing rates were 53.0% (95% CI, 45.3%-60.7%) and 50.9% (42.6%-59.2%) and inappropriate/rarely appropriate rates were 19.1% (11.4%-26.8%) and 28.4% (23.9%-32.8%) using 2008 and 2011 AUC, respectively. Stress MPI appropriate testing rates were 71.1% (64.5%-77.7%) and 72.0% (67.6%-76.3%) and inappropriate/rarely appropriate rates were 10.7% (7.2%-14.2%) and 15.7% (12.4%-19.1%) using 2005 and 2009 AUC, respectively. There was no significant temporal trend toward rising rates of appropriateness for stress echocardiography or MPI. Unclassified stress echocardiograms fell by 79% (p = 0.04) with updated AUC. There were no differences between cardiac specialists and internists. CONCLUSIONS Rates of appropriate use tend to be lower for stress echocardiography compared to MPI, and updated AUC reduced unclassified stress echocardiograms. There is no conclusive evidence that AUC improved appropriate use over time. Further research is needed to determine if integration of appropriateness guidelines in academic and community settings is an effective approach to optimizing inappropriate/rarely appropriate use of stress testing and its associated costs and patient harms.
Collapse
|
29
|
George BJ, Aban IB. An application of meta-analysis based on DerSimonian and Laird method. J Nucl Cardiol 2016; 23:690-2. [PMID: 26245193 DOI: 10.1007/s12350-015-0249-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Accepted: 07/12/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Brandon J George
- Office of Energetics, University of Alabama at Birmingham, 1720 Second Avenue South, Birmingham, AL, 35294-0022, USA.
| | - Inmaculada B Aban
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| |
Collapse
|