TITLE:
Appropriate Use of Cardiac Magnetic Resonance Imaging and Its Impact on Downstream Resource Utilization
AUTHORS:
Tiberio Frisoli, Joseph Gibbs, Karthik Ananthasubramaniam
KEYWORDS:
Cardiac MRI, Appropriate Use Criteria, Utilization, Cardiac Imaging
JOURNAL NAME:
World Journal of Cardiovascular Diseases,
Vol.7 No.8,
August
11,
2017
ABSTRACT: Purpose: Echocardiography and nuclear perfusion imaging studies ordered for appropriate indications by Appropriate Use Criteria (AUC) have been shown more likely to impact management than studies deemed inappropriate or uncertain. We sought to evaluate the appropriateness of indications for all cardiac magnetic resonance imaging (CMR) testing done at our institution in 2011, and to what extent appropriateness of CMR was associated with impact on patient management. Methods: This was a single-center retrospective cohort study including 239 consecutive patients who received CMR over the 12-month calendar period in 2011. CMR studies were classified as appropriate, uncertain or inappropriate based on the 2006 AUC. A study was deemed to have had impact if it changed or clarified the patient’s diagnosis or directly influenced downstream decision-making by subspecialty referral, further testing or treatment changes. Results: The most common indications for CMR included evaluation of cardiomyopathy (79%), valvular pathology (8%), suspected myocarditis (8%), and cardiac masses (5%). Of CMRs performed, 96% were appropriate, 1% inappropriate, and 3% uncertain. Appropriate CMRs were more likely to be associated with changes in management (90%) than inappropriate or uncertain studies (40%), with an odds ratio of 21.5:1. The most common reasons CMR classified as appropriate did not change management were 1) incomplete study, 2) physician judgment not to take action based on the CMR result and 3) hypertrophic cardiomyopathy in specific circumstances. Conclusions: Appropriate CMR studies were more likely to impact management than inappropriate/uncertain studies. When ordered for appropriate indications, CMR has demonstrable impact on patient management decisions.