21% of newly diagnosed heart failure patients don’t undergo cardiovascular testing

Rates of cardiovascular testing among incident heart failure patients varied widely in a study published June 18 in the Journal of the American College of Cardiology: Cardiovascular Imaging. One-fifth of patients were not tested at all during the four months before and the six months following their hospitalization for heart failure.

Declines have been noted in age-adjusted, cardiovascular heart failure, thanks to advances in prevention and treatment of cardiovascular disease earlier in the disease progression. Researchers noted that imaging costs have increased significantly since 2001 and a third of those costs have been in the field of cardiovascular imaging.

Stephen A. Farmer, MD, PhD, of Northwestern University’s Feinberg School of Medicine in Chicago, and colleagues followed 5,878 patients hospitalized with newly diagnosed heart failure in the Cardiovascular Research Network Heart Failure Cohort between 2005 and 2008 to determine outcomes concurrent with the amount of imaging the patients underwent. They found evidence that 79.1 percent of those patients had imaging done 14 days before to 180 days after their initial hospitalization.

Of the patients tested, 36.9 percent had a coronary artery disease assessment, 87.9 percent had an echocardiogram and 93.4 percent had a systolic functional assessment. However repeat testing proved infrequent, even though 12.1 percent of patients were readmitted at 30 days following and 38 percent in the six month that followed.

Only 36.7 percent of patients who were readmitted during the period of the study had more than one test performed, against American College of Radiology/American College of Cardiology guidelines.

They determined that significant hospital level variation occurred, irrespective of patient case modalities. The research team expressed concern about the lack of cost-effective vs. clinical benefit review of imaging technologies and found recommendations for use not clear for variations in heart failure and cardiovascular disease modalities.

Farmer et al were uncertain as to specific reasons for the range of coverage in testing. They noted that different tests offer overlapping information but are not necessarily clinically interchangeable and range in cost and invasiveness.

“We were unable to assess why 11.4% of patients underwent both a stress echocardiogram and a SPECT study. This combination may reflect poor endocardial definition or failure to reach the target heart rate on the stress echocardiogram, but could also reflect perceived complementarity between these tests,” they wrote.

More consideration of appropriateness in testing is needed to determine both cost effectiveness and clinical usefulness as guidelines are developed in the future, they proposed.