Characteristics and key differences between patient populations receiving imaging modalities for coronary artery disease diagnosis in the US

• Published in: BMC cardiovascular disorders Vol. 23; no. 1; p. 251
• Main Authors: Pelletier-Galarneau, Matthieu, Vandenbroucke, Emily, Lu, Minyi, Li, Olivia
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 15.05.2023; BioMed Central; BMC
• Subjects: Analysis; Angiography; Angioplasty; Cardiovascular disease; Care and treatment; Comorbidity; Computed tomography; Computed Tomography Angiography - methods; Coronary angiography; Coronary Angiography - methods; Coronary artery disease; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - epidemiology; Coronary heart disease; Coronary vessels; Diabetes; Diagnosis; Diagnostic imaging; Diagnostic tests; Echocardiography; Electronic health records; Electronic medical records; Heart attacks; Heart diseases; Heart failure; Humans; Hypertension; Ischemia; Longitudinal studies; Low income groups; Males; Medical care, Cost of; Medical imaging; Medical referrals; Myocardial perfusion imaging; Myocardial Perfusion Imaging - methods; Patients; Positron emission tomography; Single photon emission computed tomography; SPECT imaging; Tomography; Tomography, Emission-Computed, Single-Photon - methods; Vein & artery diseases; United States; United States > US; Coronary angiography; Single-photon emission computed tomography; Myocardial perfusion imaging; Diagnostic imaging; Coronary artery disease
• ISSN: 1471-2261; 1471-2261
• DOI: 10.1186/s12872-023-03218-7

There are limited data on the impact of imaging modality selection for the assessment of coronary artery disease (CAD) risk on downstream resource utilisation. This study sought to identify differences between patient populations in the US undergoing stress echocardiography, single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI), positron emission tomography (PET) MPI, and coronary computed tomography angiography (cCTA) for the assessment of CAD risk, and associated physician referral patterns. Claims and electronic health records data for 2.5 million US patients who received stress echocardiography, cCTA, SPECT MPI or PET MPI between January 2016 and March 2018, from the Decision Resources Group Real-World Evidence US Data Repository, were analysed. Patients were stratified into suspected and existing CAD cohorts, and further stratified by pre-test risk and presence and recency of interventions or acute cardiac events (within 1-2 years pre-index test). Linear and logistic regression were used to compare numeric and categorical variables. Physicians were more likely to refer patients to standalone SPECT MPI (77%) and stress echocardiography (18%) than PET MPI (3%) and cCTA (2%). Overall, 43% of physicians referred more than 90% of their patients to standalone SPECT MPI. Just 3%, 1% and 1% of physicians referred more than 90% of their patients to stress echocardiography, PET MPI or cCTA. At the aggregated imaging level, patients who underwent stress echocardiography or cCTA had similar comorbidity profiles. Comorbidity profiles were also similar for patients who underwent SPECT MPI and PET MPI. Most patients underwent SPECT MPI at the index date, with very few undergoing PET MPI or cCTA. Patients who underwent cCTA at the index date were more likely to undergo additional imaging tests compared with those who underwent other imaging modalities. Further evidence is needed to understand factors influencing imaging test selection across patient populations.