Taking the Pulse: a Retrospective, Population-based Analysis of Alberta’s Privatization of Cardiac Testing

BACKGROUND: Many provinces are considering an expanded role for for-profit diagnostic imaging facilities. We describe trends over time in the use of cardiac imaging studies, a subset of diagnostic imaging, in the for-profit and publicly operated facilities in Alberta. Alberta has allowed testing in private facilities since the 1970s, with formalized guidelines released in 1998. METHODS: We performed a retrospective, population-based analysis using administrative data from Alberta, Canada between 1995 and 2020 to describe the annual rates of cardiac diagnostic tests for both inpatient and outpatient settings, and trends in invasive cardiac treatments like angioplasty and coronary artery bypass grafting. RESULTS: A 3.95-fold increase in the rate of outpatient cardiac imaging per 100,000 Albertans was observed between 1998 and 2020, driven by an increase in testing at private, for-profit facilities. The rate of invasive cardiac treatments did not increase substantially over this same period. This has resulted in a net cost to Alberta of over $694 million (in 2020 dollars) in additional spending above predicted levels since 1998. CONCLUSIONS: After the implementation of imaging guidelines, a sustained and substantial increase in cardiac imaging facilities and rates was observed, including in Albertans classified as low risk for cardiac disease. A similar increase was not observed among cardiac treatment procedures, which would be anticipated if increased testing was due to changes in underlying population risk.