Abstract 13638: Impact of Cardiac Magnetic Resonance Imaging on Utilization of Invasive Cardiac Procedures

Abstract

Background - There is growing concern from government and payers regarding rising healthcare costs related to possible overutilization of invasive cardiac procedures. Cardiac magnetic resonance imaging (CMR) can provide unique diagnostic and prognostic information in patients with a wide variety of conditions. We therefore hypothesized that information derived from CMR may lead to more optimal utilization of invasive cardiac procedures leading to significant reductions in downstream procedural interventions. The aim of this study was to identify the immediate clinical impact of CMR on utilization of invasive cardiac procedures.

Methods and Results - Three-hundred fifty consecutive patients referred for CMR were prospectively enrolled in a single center registry. Definitions for significant change in utilization of invasive procedures were pre-defined and collected directly from medical records. Significant change in utilization of the following invasive procedures was measured: coronary angiography, percutaneous coronary intervention (PCI), intra-cardiac biopsy, cardiothoracic surgery and ICD implantation. Overall a change in utilization of invasive cardiac procedures occurred in 23% of patients, with increased utilization in 11% and decreased utilization in 13%. Of these patients, CMR results led directly to angiography in 15%, avoided angiography in 18%, led to PCI in 12%, avoided PCI in 7%, led to intracardiac biopsy in 2%, avoided intracardiac biopsy in 5%, led to cardiothoracic surgery in 10%, avoided cardiothoracic surgery in 12%, led to ICD implantation in 6%, and avoided ICD implantation in 12%.

Conclusions - CMR led to a direct change in utilization of invasive cardiac procedures in 23% of cases. Both increased and decreased use was noted, with an overall net decrease in utilization - particularly ICD implantations. Further studies are required to assess the cost implications of these findings.