Abstract 19407: Did the Appropriate Use Criteria Change Ordering Patterns of Myocardial Perfusion Imaging Among Physicians in a Large Tertiary Cardiac Centre?
Aim: To assess the effects of use of appropriate use criteria (AUC) for myocardial perfusion imaging (MPI) on the ordering patterns of physicians over a period of one year.
Methods: We embarked on an exploratory, prospective pre- and post-intervention study of all consecutive MPI studies referred to a single centre between 16th February 2009 and 12th February 2010. The study intervention included dissemination of the ACCF/ASNC 2009 AUC for Cardiac Radionuclide Imaging guidelines and delivery of didactic lectures and discussions about AUC to physicians who were authorized to order MPI studies. Each MPI study was categorized as normal or abnormal [fixed defect, completely reversible defect(s), or a partially reversible defect(s)].
Results: We evaluated 2033 referrals for MPI over a one year period. Compared to the pre-intervention period, there was an increase in the proportion of appropriate referrals (73% vs. 79.5%, p=0.001) and decrease in the proportion of inappropriate referrals (17.5% vs. 12.1%, p=0.001) in the post-intervention period. Appropriate referrals among the preoperative group increased from 13.8% to 18.6% (p=0.005); largely due to increase in appropriate referrals of high-risk and intermediate-risk patients with poor functional class from 30.6% (49 of 160) to 92.3% (144 of 156) (p<0.001). Inappropriate referrals for evaluation of patients with ischemic equivalent in the non-acute setting declined from 26.0% (79 of 305) to 8.0% (15 of 192) (p<0.001), particularly in low-risk patients (2.7% vs. 1.1%) who were less likely to have an abnormal MPI scan (OR 0.2, 0.06-0.46 p<0.001). Among patients without ischemic equivalent, inappropriate use of MPI declined from 45.6% (88 of 193) to 14.1% (13 of 92) (p=0.006), predominantly in low-risk patients (4.9% vs. 2.6%, p=0.007) who were less likely to have an abnormal MPI scan (OR 0.3, 0.16-0.45, p<0.001).
Conclusion: We have demonstrated a change in the ordering practices of physicians after implementation of current AUC for MPI testing. The reductions in inappropriate referrals of low-risk patients and increase in appropriate referrals of patients prior to non-cardiac surgery are significant and warrant further investigation into the clinical implications and cost-effectiveness of these changes.
- © 2010 by American Heart Association, Inc.