title: Decreasing outpatient cardiac catheterization rates associated with cardiology clinic volume but not with increasing cardiac computed tomography utilization.
abstract: Cardiac computed tomographic angiography (CTA) is an accurate noninvasive test for diagnosing coronary artery disease (CAD). To investigate whether increasing use of CTA is correlated with left heart catheterization (LHC) rates, we performed a retrospective review of existing outpatient and inpatient catheterization lab and CTA electronic medical records from July 1, 2004 to June 30, 2008. Comparing the previous 2 years (July 2004-June 2006) to the 2 years after addition of CTA (July 2006-June 2008), monthly LHC rates decreased 20 +/- 6% (p = 0.08) and percutaneous coronary intervention (PCI) rates decreased 47 +/- 6% (p<0.001). Cardiology clinic volume declined 34%. CTA rates increased 64 +/- 7% (p<0.001). Radionuclide myocardial perfusion scan (MPS) usage remained stable. Despite increased utilization over the past 2 years, CTA was not correlated with significantly reduced LHC rates. The decline of outpatient LHC rates at our institution over 4 years is mainly influenced by decreasing outpatient Cardiology clinic volume.
authors.affiliation: Cardiology Service, Department of Internal Medicine, Walter Reed Army Medical Center, 6900 Georgia Ave. NW, Washington, DC 20307, USA.
authors.forename: Eddie
authors.initials: E
authors.lastname: Hulten
authors.forename: Salvatore
authors.initials: S
authors.lastname: Carbonaro
authors.forename: Barnett
authors.initials: B
authors.lastname: Gibbs
authors.forename: Michael
authors.initials: M
authors.lastname: Cheezum
authors.forename: Irwin
authors.initials: I
authors.lastname: Feuerstein
authors.forename: Daniel
authors.initials: D
authors.lastname: Simpson
authors.forename: Allen J
authors.initials: AJ
authors.lastname: Taylor
authors.forename: Todd C
authors.initials: TC
authors.lastname: Villines
mesh_terms: D000368:Aged; D006328:Cardiac Catheterization / Q000706:statistics & numerical data*; D003327:Coronary Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging; D005260:Female; D006772:Hospitals, Military; D006801:Humans; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*