title: Perceived usefulness of cardiac computed tomography as assessed by referring physicians and its effect on patient management.
abstract: Despite the growing use of computed tomographic angiography (CTA), the effect on patient management is less clear. We sought to determine the perceived usefulness of the results provided by CTA and to assess whether and how it influences patient management. Comprehensive prospective data were collected from 184 consecutive patients who presented for clinical CTA for the evaluation of coronary artery disease from March to July 2008. In addition, a detailed survey was sent to each referring physician for each patient examined to assess whether they found the results of the CTA useful and whether it had any influence on subsequent patient management. Of 184 CTA examinations, which had been ordered by 82 different providers, 108 surveys (59%) were completed by 53 different physicians. No significant differences were found in either the patient or provider characteristics for the completed versus noncompleted surveys. Of the 184 CTA examinations, the severity of coronary disease detected by CTA was severe for 26%, mild to moderate in 47%, and not present in 27% of the patients. Clinicians considered the test results to be useful in virtually all cases and thought the results led to significant risk reclassification in 58% of the patients. If CTA had not been available, the clinicians indicated that they would have ordered an invasive test for 46% of the patients and noninvasive tests for 32%. After CTA, changes in medical therapies were made for 31%, invasive angiography was planned for 19%, and noninvasive testing was scheduled for 6% of the patients. In conclusion, of 53 different referring clinicians from different medical specialties, CTA was considered to almost always be useful; however, the effect on subsequent medical management was more variable.
authors.affiliation: Cardiac MR PET CT Program, Department of Radiology and Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA. rblankstein@partners.org
authors.forename: Ron
authors.initials: R
authors.lastname: Blankstein
authors.forename: Meagan K
authors.initials: MK
authors.lastname: Murphy
authors.forename: Khurram
authors.initials: K
authors.lastname: Nasir
authors.forename: G Scott
authors.initials: GS
authors.lastname: Gazelle
authors.forename: Juan C
authors.initials: JC
authors.lastname: Batlle
authors.forename: Mouaz
authors.initials: M
authors.lastname: Al-Mallah
authors.forename: Leon
authors.initials: L
authors.lastname: Shturman
authors.forename: Udo
authors.initials: U
authors.lastname: Hoffmann
authors.forename: Ricardo C
authors.initials: RC
authors.lastname: Cury
authors.forename: Suhny
authors.initials: S
authors.lastname: Abbara
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Brady
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Lee
mesh_terms: D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D012017:Referral and Consultation; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D014057:Tomography, X-Ray Computed