Appropriate Use Criteria for Cardiac Computed Tomography

Does Computed Tomography Have Incremental Value in All Appropriate Use Criteria Categories?

Fernanda Erthal, Manuja Premaratne, Yeung Yam, Li Chen, Jasmine Lamba, Marissa Keenan, Tony Haddad, Kishu Pharasi, Saipriya Anand, Rob S. Beanlands, Ian G. Burwash, Girish Dwivedi, Terrence D. Ruddy, Benjamin J.W. Chow

Research output: Contribution to journalArticleResearchpeer-review

5 Citations (Scopus)

Abstract

Purpose: Cardiac imaging expenditures have come under scrutiny, and a focus on appropriate use criteria (AUC) has arisen to ensure cost-effective resource utilization. Although AUC has been developed by clinical experts, it has not undergone rigorous quality assurance testing to ensure that inappropriate indications for testing yield little clinical benefit. The objective of the study was to evaluate the potential incremental prognostic value of coronary computed tomographic angiography (CCTA) in the different AUC categories. Materials and Methods: Consecutive patients enrolled into a cardiac CT Registry were collated. Patient indications were reviewed and based on the 2010 AUC (appropriate, uncertain, and inappropriate). Patients were followed-up for death, myocardial infarction (MI), and late revascularization, with the primary composite endpoint being cardiac death, nonfatal MI, and late revascularization. The prognostic value of CCTA over clinical variables in each of the AUC categories was assessed. Results: Indications for CCTA were appropriate, uncertain, and inappropriate in 1284 (66.5%), 312 (16.2%), and 334 (17.3%) patients, respectively. Rates of all-cause of death, cardiac death, nonfatal MI, and late revascularization were similar across patients with appropriate, uncertain, and inappropriate indications for CCTA. Moreover, in each AUC category, CCTA had incremental prognostic value over a routine clinical risk score (National Cholesterol Education Program) with hazard ratios of 9.98, 7.39, and 5.61. Conclusions: CCTA has incremental prognostic value in all AUC categories, even when the reason for the study was deemed "inappropriate." This suggests that CCTA may still have clinical value in "inappropriate" indications and that further quality assurance AUC studies are needed.

Original languageEnglish
Pages (from-to)132-137
Number of pages6
JournalJournal of Thoracic Imaging
Volume33
Issue number2
DOIs
Publication statusPublished - 1 Jan 2018
Externally publishedYes

Keywords

  • appropriate use criteria
  • cardiac computed tomography
  • prognosis

Cite this

Erthal, Fernanda ; Premaratne, Manuja ; Yam, Yeung ; Chen, Li ; Lamba, Jasmine ; Keenan, Marissa ; Haddad, Tony ; Pharasi, Kishu ; Anand, Saipriya ; Beanlands, Rob S. ; Burwash, Ian G. ; Dwivedi, Girish ; Ruddy, Terrence D. ; Chow, Benjamin J.W. / Appropriate Use Criteria for Cardiac Computed Tomography : Does Computed Tomography Have Incremental Value in All Appropriate Use Criteria Categories?. In: Journal of Thoracic Imaging. 2018 ; Vol. 33, No. 2. pp. 132-137.
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title = "Appropriate Use Criteria for Cardiac Computed Tomography: Does Computed Tomography Have Incremental Value in All Appropriate Use Criteria Categories?",
abstract = "Purpose: Cardiac imaging expenditures have come under scrutiny, and a focus on appropriate use criteria (AUC) has arisen to ensure cost-effective resource utilization. Although AUC has been developed by clinical experts, it has not undergone rigorous quality assurance testing to ensure that inappropriate indications for testing yield little clinical benefit. The objective of the study was to evaluate the potential incremental prognostic value of coronary computed tomographic angiography (CCTA) in the different AUC categories. Materials and Methods: Consecutive patients enrolled into a cardiac CT Registry were collated. Patient indications were reviewed and based on the 2010 AUC (appropriate, uncertain, and inappropriate). Patients were followed-up for death, myocardial infarction (MI), and late revascularization, with the primary composite endpoint being cardiac death, nonfatal MI, and late revascularization. The prognostic value of CCTA over clinical variables in each of the AUC categories was assessed. Results: Indications for CCTA were appropriate, uncertain, and inappropriate in 1284 (66.5{\%}), 312 (16.2{\%}), and 334 (17.3{\%}) patients, respectively. Rates of all-cause of death, cardiac death, nonfatal MI, and late revascularization were similar across patients with appropriate, uncertain, and inappropriate indications for CCTA. Moreover, in each AUC category, CCTA had incremental prognostic value over a routine clinical risk score (National Cholesterol Education Program) with hazard ratios of 9.98, 7.39, and 5.61. Conclusions: CCTA has incremental prognostic value in all AUC categories, even when the reason for the study was deemed {"}inappropriate.{"} This suggests that CCTA may still have clinical value in {"}inappropriate{"} indications and that further quality assurance AUC studies are needed.",
keywords = "appropriate use criteria, cardiac computed tomography, prognosis",
author = "Fernanda Erthal and Manuja Premaratne and Yeung Yam and Li Chen and Jasmine Lamba and Marissa Keenan and Tony Haddad and Kishu Pharasi and Saipriya Anand and Beanlands, {Rob S.} and Burwash, {Ian G.} and Girish Dwivedi and Ruddy, {Terrence D.} and Chow, {Benjamin J.W.}",
year = "2018",
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Erthal, F, Premaratne, M, Yam, Y, Chen, L, Lamba, J, Keenan, M, Haddad, T, Pharasi, K, Anand, S, Beanlands, RS, Burwash, IG, Dwivedi, G, Ruddy, TD & Chow, BJW 2018, 'Appropriate Use Criteria for Cardiac Computed Tomography: Does Computed Tomography Have Incremental Value in All Appropriate Use Criteria Categories?', Journal of Thoracic Imaging, vol. 33, no. 2, pp. 132-137. https://doi.org/10.1097/RTI.0000000000000297

Appropriate Use Criteria for Cardiac Computed Tomography : Does Computed Tomography Have Incremental Value in All Appropriate Use Criteria Categories? / Erthal, Fernanda; Premaratne, Manuja; Yam, Yeung; Chen, Li; Lamba, Jasmine; Keenan, Marissa; Haddad, Tony; Pharasi, Kishu; Anand, Saipriya; Beanlands, Rob S.; Burwash, Ian G.; Dwivedi, Girish; Ruddy, Terrence D.; Chow, Benjamin J.W.

In: Journal of Thoracic Imaging, Vol. 33, No. 2, 01.01.2018, p. 132-137.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Appropriate Use Criteria for Cardiac Computed Tomography

T2 - Does Computed Tomography Have Incremental Value in All Appropriate Use Criteria Categories?

AU - Erthal, Fernanda

AU - Premaratne, Manuja

AU - Yam, Yeung

AU - Chen, Li

AU - Lamba, Jasmine

AU - Keenan, Marissa

AU - Haddad, Tony

AU - Pharasi, Kishu

AU - Anand, Saipriya

AU - Beanlands, Rob S.

AU - Burwash, Ian G.

AU - Dwivedi, Girish

AU - Ruddy, Terrence D.

AU - Chow, Benjamin J.W.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Purpose: Cardiac imaging expenditures have come under scrutiny, and a focus on appropriate use criteria (AUC) has arisen to ensure cost-effective resource utilization. Although AUC has been developed by clinical experts, it has not undergone rigorous quality assurance testing to ensure that inappropriate indications for testing yield little clinical benefit. The objective of the study was to evaluate the potential incremental prognostic value of coronary computed tomographic angiography (CCTA) in the different AUC categories. Materials and Methods: Consecutive patients enrolled into a cardiac CT Registry were collated. Patient indications were reviewed and based on the 2010 AUC (appropriate, uncertain, and inappropriate). Patients were followed-up for death, myocardial infarction (MI), and late revascularization, with the primary composite endpoint being cardiac death, nonfatal MI, and late revascularization. The prognostic value of CCTA over clinical variables in each of the AUC categories was assessed. Results: Indications for CCTA were appropriate, uncertain, and inappropriate in 1284 (66.5%), 312 (16.2%), and 334 (17.3%) patients, respectively. Rates of all-cause of death, cardiac death, nonfatal MI, and late revascularization were similar across patients with appropriate, uncertain, and inappropriate indications for CCTA. Moreover, in each AUC category, CCTA had incremental prognostic value over a routine clinical risk score (National Cholesterol Education Program) with hazard ratios of 9.98, 7.39, and 5.61. Conclusions: CCTA has incremental prognostic value in all AUC categories, even when the reason for the study was deemed "inappropriate." This suggests that CCTA may still have clinical value in "inappropriate" indications and that further quality assurance AUC studies are needed.

AB - Purpose: Cardiac imaging expenditures have come under scrutiny, and a focus on appropriate use criteria (AUC) has arisen to ensure cost-effective resource utilization. Although AUC has been developed by clinical experts, it has not undergone rigorous quality assurance testing to ensure that inappropriate indications for testing yield little clinical benefit. The objective of the study was to evaluate the potential incremental prognostic value of coronary computed tomographic angiography (CCTA) in the different AUC categories. Materials and Methods: Consecutive patients enrolled into a cardiac CT Registry were collated. Patient indications were reviewed and based on the 2010 AUC (appropriate, uncertain, and inappropriate). Patients were followed-up for death, myocardial infarction (MI), and late revascularization, with the primary composite endpoint being cardiac death, nonfatal MI, and late revascularization. The prognostic value of CCTA over clinical variables in each of the AUC categories was assessed. Results: Indications for CCTA were appropriate, uncertain, and inappropriate in 1284 (66.5%), 312 (16.2%), and 334 (17.3%) patients, respectively. Rates of all-cause of death, cardiac death, nonfatal MI, and late revascularization were similar across patients with appropriate, uncertain, and inappropriate indications for CCTA. Moreover, in each AUC category, CCTA had incremental prognostic value over a routine clinical risk score (National Cholesterol Education Program) with hazard ratios of 9.98, 7.39, and 5.61. Conclusions: CCTA has incremental prognostic value in all AUC categories, even when the reason for the study was deemed "inappropriate." This suggests that CCTA may still have clinical value in "inappropriate" indications and that further quality assurance AUC studies are needed.

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KW - cardiac computed tomography

KW - prognosis

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