Abstract 14368: Cardiac Stress Test Trends Among Patients Under Age 65 in the United States, 2005-2012
Introduction: After a period of rapid growth, utilization of cardiac stress testing has recently decreased among Medicare beneficiaries and in a large integrated health system. However, it is not known whether declines in stress test use are universal, or are confined to certain populations or payment models.
Methods: Using comprehensive administrative claims from a national managed care company, we conducted a serial cross-sectional study with time trends among patients aged 25-64 who underwent cardiac stress testing between 2005 and 2012. We calculated age- and sex-adjusted rates of stress tests per calendar quarter, and estimated linear trends in rates using negative binomial regression models with calendar quarter as the key independent variable. Age- and sex-adjusted rates of hospitalization for acute ST-segment elevation myocardial infarction (STEMI) were used to estimate contemporaneous trends in a key adverse outcome of coronary artery disease.
Results: We identified 2,085,591 stress tests performed among 32,921,838 unique persons. There was a small (2%) increase in stress test rates from 2005 to 2012 (3486 [95% CI: 3458 to 3514] versus 3552 [95% CI: 3522 to 3582] tests per 100,000 person-years; p for linear trend=0.01). Declines in nuclear single photon emission computed tomography (a 15% relative decrease; p=0.03) were offset by increases in the use of stress echocardiography (a 24% relative increase; p<.001), exercise electrocardiography (a 10% relative increase; p<.001), and other stress testing modalities (a 66% relative increase; p<.001). Rates of stress testing increased most significantly among members aged 25-34 years (a 70% relative increase; p<.001). The incidence of STEMI remained stable from 2005 to 2012 (43 [95% CI 39 to 47] versus 47 [95% CI 43 to 51] hospitalizations per 100,000 person-years; p=0.20).
Conclusions: In contrast to declines in stress test use in some health care systems, we observed a small increase in stress test utilization among a large and diverse cohort of commercially insured patients. Our findings suggest that observed trends in stress test utilization may have been driven more strongly by unique characteristics of populations and health systems than national efforts to reduce overuse of testing.
Author Disclosures: V. Kini: None. F. McCarthy: None. E. Dayoub: None. S. Bradley: None. F. Masoudi: None. P. Ho: None. P. Groeneveld: None.
- © 2016 by American Heart Association, Inc.