Abstract 13301: Comparative Utilization of Cardiac Stress Testing in US Patients With and without Chronic Kidney Disease
Introduction: A “nihilistic approach” to coronary artery disease (CAD) in pts with chronic kidney disease (CKD) has previously been reported. We have revisited this “truism” in the context of cardiac stress testing in the modern era (2008-12).
Methods: The 20% Medicare sample was searched by single cohort years (2008-12) to identify pts age 65+ with no CKD (n = 4,232,080 in 2012) and Stages 1-5D CKD (n= 332,058 in 2012). Rates of non-invasive CAD testing (Stress: Echo, Nuclear, MRI, and ECG and CT: angiography or Calcium score) were estimated within each cohort by year.
Results: Non-CKD demographics (2012): 33% age 75-84, 14% age 85+, 87% white, 7% black, 42% male; CKD (2012): 41% age 75-84, 25% age 85+, 81% white, 13% black, 47% male, 7% CKD stages 1 & 2, 64% 3,4,5ND, 7% ESRD, and 22% unknown stage. Demographics of pts receiving tests (2012): non-CKD: 35% age 75-84, 6% age 85+, 88% white, 7% black, 48% male; CKD: 44% age 75-84, 10% age 85+, 80% white, 13% black, 54% male, 7% CKD stages 1 & 2, 67% 3,4,5ND, 8% ESRD and 17% unknown stage. The rate of stress testing (per 100 pt-yrs) was 11.5 for non-CKD and 16.8 for CKD pts in 2008, declining to 9.4 and 13.4 respectively in 2012 (see figure for stress testing rate by yr). Stress nuclear testing predominated: 80.3% (non-CKD) and 88.2% (CKD) of all stress tests in 2008 and 77.7% (non-CKD) and 87.1% (CKD) in 2012 vs stress echo: 11.6% (non-CKD) and 7.4% (CKD) in 2008 and 12.6% (non-CKD) and 7.4% (CKD) in 2012. Approximately 2,000,000 Medicare pts age 65+ received a stress test In 2012.
Conclusions: There has been a progressive decline in rates of stress testing in both non-CKD and CKD pts from 2008 to 2012. Stress nuclear imaging accounts for more than three-fourths of all stress tests. CKD pts have a consistently higher rate of stress testing compared to non-CKD pts in 2008-12. Commonly held perceptions of under-utilization of stress testing for CAD in CKD pts are false in the current era.
Author Disclosures: C.A. Herzog: Employment; Significant; Hennepin Healthcare System, Inc.. Research Grant; Significant; Amgen, Zoll. Honoraria; Modest; UpToDate. Ownership Interest; Modest; Boston Scientific, GE, Johnson & Johnson, Merck. Consultant/Advisory Board; Modest; AbbVie, BMS, Davita Clinical Research, Relypsa, ZS Pharma. Consultant/Advisory Board; Significant; FibroGen. T. Natwick: None. S. Li: None. D.M. Charytan: Employment; Significant; Brigham & Women’s Hospital. Research Grant; Significant; Janssen, Medtronic. Expert Witness; Modest; Fresenius. Consultant/Advisory Board; Modest; Lilly/Boehringer Ingelheim, Medtronic.
- © 2016 by American Heart Association, Inc.