May 15, 2023Open Access
Characteristics and key differences between patient populations receiving imaging modalities for coronary artery disease diagnosis in the US
Key Result
Physicians were significantly more likely to refer patients for standalone SPECT MPI (77%) and stress echocardiography (18%) than for PET MPI (3.2%) or cCTA (2.1%) for coronary artery disease risk assessment.
Study Design
Type
Observational (n=2,500,000)
Multicenter
Yes
Structured PICO
Does the choice of imaging modality affect downstream resource utilization in patients with suspected or existing CAD?
P
Population
2.5 million US patients with suspected or existing coronary artery disease who underwent stress echocardiography, SPECT MPI, PET MPI, or cCTA between 2016 and 2018.
E
Exposure
Imaging modalities for CAD risk assessment (stress echocardiography, SPECT MPI, PET MPI, cCTA)
C
Comparator
Comparison between different imaging modalities (stress echocardiography, SPECT MPI, PET MPI, cCTA)
O
Outcome
Differences between patient populations undergoing different imaging modalities and associated physician referral patterns (downstream resource utilization)
In real-world US practice, SPECT MPI is the most frequently utilized imaging modality for CAD assessment, while cCTA is rarely used but associated with higher rates of downstream non-invasive imaging.
Limitations
- Real-world data obtained from routine clinical practice are prone to missing and erroneous data, coding imperfections, and lack of standardization.
- Certain covariates of interest (e.g., comorbidities) may not be recorded consistently in the database.
- Conducted on a US population and therefore may not be generalizable to other populations with different healthcare trends.
Abstract
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.