Comparison of professional medical society guidelines for appropriate use of coronary computed tomography angiography
| Autor: | Tushar Acharya, Eric S. Leifer, Marcus Y. Chen, Daniel W. Groves, Eileen Hu-Wang, Jeannie H. Yu, Faraz Kureshi, Sujata M Shanbhag, Bharath Sathya, W. Patricia Bandettini |
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| Rok vydání: | 2019 |
| Předmět: |
Adult
Male medicine.medical_specialty Percentile Computed Tomography Angiography Coronary Artery Disease 030204 cardiovascular system & hematology Coronary Angiography Appropriate Use Criteria 030218 nuclear medicine & medical imaging Coronary artery disease 03 medical and health sciences 0302 clinical medicine Cohen's kappa Predictive Value of Tests Internal medicine Medicine Humans Radiology Nuclear Medicine and imaging Prospective Studies Prospective cohort study Reimbursement Societies Medical Aged Aged 80 and over business.industry Middle Aged medicine.disease Confidence interval Practice Guidelines as Topic Female Cardiology and Cardiovascular Medicine business Kappa |
| Zdroj: | Journal of cardiovascular computed tomography. 14(6) |
| ISSN: | 1876-861X |
| Popis: | Background Multiple appropriate use criteria (AUC) exist for the evaluation of coronary artery disease (CAD), but there is little data on the agreement between AUC from different professional medical societies. The aim of this study is to compare the appropriateness of coronary computed tomography angiography (CCTA) exams assessed using multimodality AUC from the American College of Cardiology Foundation (ACCF) versus the American College of Radiology (ACR). Methods In a single-center prospective cohort study from June 2014 to 2016, 1005 consecutive subjects referred for evaluation of known or suspected CAD received a contrast-enhanced CCTA. The primary outcome was the agreement of appropriateness ratings using ACCF and ACR guidelines, measured by the kappa statistic. A secondary outcome was the rate of obstructive CAD by appropriateness rating. Results Among 1005 subjects, the median (5–95th percentile) age was 59 (37–76) years with 59.0% male. The ACCF criteria classified 39.6% (n = 398) appropriate, 24.2% (n = 243) maybe appropriate, and 36.2% (n = 364) rarely appropriate. The ACR guidelines classified 72.3% (n = 727) appropriate, 2.6% (n = 26) maybe appropriate, and 25.1% (n = 252) rarely appropriate. ACCF and ACR appropriateness ratings were in agreement for 55.0% (n = 553). Overall, there was poor agreement (kappa 0.27 [95% confidence interval 0.23–0.31]). By both AUC methods, a low rate of obstructive CAD was observed in the rarely appropriate exams (ACCF 7.1% [n = 26 of 364] and ACR 13.5% [n = 34 of 252]). Conclusions Compared to ACCF criteria, the ACR guidelines of appropriateness were broader and classified significantly more CCTA exams as appropriate. The poor agreement between appropriateness ratings from the ACCF and ACR AUC guidelines evokes implications for reimbursement and future test utilization. |
| Databáze: | OpenAIRE |
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