Healthcare resource utilization among patients receiving non-invasive testing for coronary artery disease in an outpatient setting: A cohort study reflecting daily practice trends

• Published in: Journal of nuclear cardiology Vol. 29; no. 4; pp. 1776 - 1787
• Main Authors: Ananthasubramaniam, Karthikeyan, Kitt, Therese M., Saxena, Akansha, Feng, Qi, Nimke, David, Spalding, James R., Xu, Yanqing
• Format: Journal Article
• Language: English
• Published: Cham Elsevier Inc 01.08.2022; Springer International Publishing; Springer Nature B.V
• Subjects: Adolescent; Adult; CAD < diseases/processes; Cardiology; Cardiovascular disease; Cohort analysis; Cohort Studies; Coronary Angiography - methods; Coronary Artery Disease - complications; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - therapy; Coronary vessels; Delivery of Health Care; Diagnostic and prognostic application < outcomes; Diagnostic tests; ETT < tests; Humans; Imaging; Medical diagnosis; Medicine; Medicine & Public Health; Nuclear Medicine; Original Article; Outpatients; Radiology; Retrospective Studies; SPECT < modalities; Tomography, Emission-Computed, Single-Photon; Vein & artery diseases; ETT < tests; SPECT < modalities; CAD < diseases/processes; Diagnostic and prognostic application < outcomes
• ISSN: 1071-3581; 1532-6551
• DOI: 10.1007/s12350-021-02549-2

Accurate, early diagnosis and the initiation of appropriate treatment is central to reducing the clinical burden of coronary artery disease (CAD); however, real-world evidence characterizing healthcare resource utilization (HCRU) associated with testing for CAD is lacking. Using a non-interventional, retrospective, secondary database analysis, patients aged ≥18 years who underwent outpatient non-invasive cardiac diagnostic testing were identified. The primary objective was to gain an understanding of pre- and post-assessment care pathways and the associated interventions for patients who underwent non-invasive testing for CAD in either an outpatient or emergency department setting. Overall, chest pain was the primary reason for the index visit (54.8%), followed by shortness of breath (23.7%), myocardial infarction (MI), coronary artery disease (CAD) or congestive heart failure (CHF) (3.8%), and other (46.8%); 3.0% of patients had no apparent reason for testing in the last 45 days. Single-photon emission computed tomography (SPECT) was the dominant diagnostic testing modality (40.3%). During the 90-day follow-up, 7.3% (n = 22,083) of patients were diagnosed with CAD; among these patients, 19.4% had repeat diagnostic testing, 26.0% of patients had a revascularization procedure, and 65.6% underwent cardiac catheterization. These rates varied by testing modality. In this study of a large real-world data sample, variability in the use of non-invasive tests and HCRU were evident. These results may assist efforts to optimize system-wide care/diagnostic pathways and value-based treatment decisions for patients.