AHA: Cardiac imaging management cuts unnecessary follow-up tests

A cardiac imaging management program prevented unnecessary imaging exams and resulted in a 12 percent reduction in the likelihood of follow-up tests, including myocardial perfusion imaging and cardiac CT scans, according to a poster presentation Nov. 4 at the American Heart Association annual scientific meeting.

“While the reduction in follow-up tests is important on its own, we can extrapolate that unnecessary catheterizations, angioplasty procedures and heart bypass procedures were prevented as well,” Andrea DeVries, director of research operations for HealthCore, said in a press release.

Previous research places the rate of inappropriate cardiac imaging exams at approximately 15 percent.

HealthCore analyzed information provided by AIM Specialty Health, a benefit management company, on a study group of 96,906 people who were members in WellPoint-affiliated health plans in Indiana, Ohio, Kentucky, Missouri and Georgia before and after a cardiac program was implemented in these states.

AIM’s cardiac imaging program applies medical necessity clinical guidelines, which were developed using the American College of Cardiology Foundation’s appropriate use criteria as a primary source, to help ensure that a requested cardiac procedure is appropriate for the patient. 

The cardiac program reviews stress echocardiography, resting transthoracic echocardiography, transesophageal echocardiography, myocardial perfusion imaging, cardiac PET, cardiac CT, cardiac MRI and blood pool imaging.

HealthCore compared patients managed through the AIM cardiac management program to others who received no management from AIM. HealthCore followed the patients’ health data for up to 24 months after their initial diagnostic test.

The researchers found that for every 100 index tests across the entire study population, the following domino effect of medical services occur within 12 months: 20 additional follow-up diagnostic tests, 10 catheterizations, three angioplasty procedures and one heart bypass surgery.

The analysis also found:

• Two out of every nine patients with a baseline diagnostic test had a follow-up test within 24 months;
• One out of every six patients with a baseline diagnostic test had a follow-up test within one year; and
• A follow-up test was most likely to happen during the first month after the initial test.

Holding other variables constant, the likelihood for downstream imaging exams increased with age, was lower for females than males and increased as member comorbidity burdens increased. As expected, in both managed and unmanaged populations, members with history of cardiovascular events had a higher likelihood of receiving downstream testing. Finally, members whose index test was a nuclear imaging test had a lower likelihood of downstream testing.