Following Appropriateness Criteria can reduce unnecessary cardiac testing
BOSTON—Hospitals that perform cardiac nuclear stress testing under the 2007 Appropriateness Criteria from the American Society of Nuclear Cardiology (ASNC) and American College of Cardiology (ACC) could reduce unnecessary testing and potentially reduce costs, according to a study presented Sept. 12 at the ASNC conference.

Karthik Ananth, MD, a cardiologist Henry Ford Hospital in Detroit and the study's senior author, presented the findings at ASNC.

Researchers examined 375 patients who underwent nuclear stress testing at Henry Ford and showed that in 90 percent of cases physicians ordered the diagnostic imaging test appropriately using the updated guidelines.

Ananth and colleagues also found that 21 patients should not have received the test because their patient profile and assessment did not meet the test criteria under the guidelines. While the patients were considered low risk for nuclear testing, none required additional testing such as a cardiac catheterization, and 95 percent of the scans in the group turned up normal.

While the study did not look at cost, the researchers theorized that there is potential for savings based on their findings. Further study will be required to determine the cost analysis, according to the researchers.

“We believe there is potential for substantial savings provided hospitals closely adhere to these test-appropriateness criteria for cardiac nuclear testing,” Ananth said.

“When followed, these criteria help physicians ensure the most effective use of cardiac nuclear testing and provide them simple clinical tools to filter out low-risk patients in whom unnecessary testing can be avoided,” he added.

In the study, researchers evaluated the practice patterns of their own cardiologists and non-cardiologists who ordered a cardiac nuclear test for patients between January-March 2007. The goal was to determine whether physicians adhered to the 52 criteria outlining when a test is appropriate or inappropriate.

An expert panel of physicians developed the criteria in response to a MedPAC report showing that cardiac imaging services rose twice the rate of growth of other physician services from 1999-2003. Based originally on existing medical evidence and the most common clinical reasons for ordering stress testing, the criteria were published in 2005 and updated two years later to guide physicians to use nuclear testing more responsibly and cost effectively.

The criteria aid physicians in identifying whether a patient should receive the nuclear test based on their medical profile. Of the 52, 27 indicators are listed as appropriate testing, 13 as inappropriate testing and 12 as uncertain, meaning testing may be acceptable but that additional research is needed to determine these criteria are appropriate or inappropriate.

Henry Ford performs about 4,000 cardiac nuclear tests annually, among the lowest in Michigan. Roughly eight million nuclear tests are performed nationally, nearly double from 10 years ago. The four-hour test typically costs about $4,000. According to ASNC, most payors cover the test.