Since 2018, non-invasive first-line diagnostic tests (cardiac CT and MPI) for new-onset heart failure have surpassed invasive coronary angiography in patients without CAD.
What are the temporal trends in the utilization of first-line diagnostic tests for etiology in patients with new-onset heart failure?
Real-world registry data from Denmark demonstrates a temporal shift since 2018 toward non-invasive modalities, particularly cardiac CT, over invasive angiography for the etiological evaluation of new-onset heart failure.
Absolute Event Rate: 0% vs 0%
Abstract Background/Introduction Establishing the etiology of new-onset heart failure (HF) is crucial for appropriate management. Current guidelines recommend diagnostic testing to identify the underlying cause, and the selection of first-line diagnostic testing is often guided by a prior risk of suspected coronary artery disease. How these testing patterns have changed over time remains poorly understood. Purpose To evaluate temporal trend in the utilization of first-line diagnostic tests, specifically cardiac computed tomography (CT), myocardial perfusion imaging (MPI) and invasive coronary angiography (ICA), in patients with new-onset HF over a 14-year period. Methods This study used data from the Western Denmark Heart Registry, identifying patients with new-onset HF between 2008 and 2021. Patients with a pre-existing diagnosis of coronary artery disease (CAD) or who underwent ICA at the time of HF diagnosis were excluded. Diagnostic testing (cardiac CT, MPI, or ICA) performed within 365 days before or 365 days after the date of HF diagnosis was considered. The primary endpoint was the choice of first-line diagnostic test. Results Overall, 17,954 patients were eligible. Of these, 2944 (16.4%) patients underwent cardiac CT, 375 (2.1%) patients underwent MPI, and 6136 (34.2%) patients underwent ICA. No diagnostic test was undertaken in 8510 (47.4%) patients. Notably, since 2018, the number of non-invasive diagnostic tests (cardiac CT and MPI combined) has exceeded the number of invasive diagnostic tests (ICA). Conclusion This study reveals distinct temporal trends in the diagnostic evaluation of new-onset HF in Denmark. While a significant proportion of patients did not undergo specific etiological testing, a shift towards non-invasive modalities, particularly cardiac CT, has been observed in recent years. Further research is needed to understand the clinical implications of these trends and to optimize diagnostic strategies for patients with new-onset HF and low pre-test probability of coronary artery disease.Flowchart Temporal trends
Graversen et al. (Sat,) reported a other. Since 2018, non-invasive first-line diagnostic tests (cardiac CT and MPI) for new-onset heart failure have surpassed invasive coronary angiography in patients without CAD.