title: Inappropriate utilization of SPECT myocardial perfusion imaging on the USA-Mexico border.
abstract: BACKGROUND
  The American College of Cardiology/American Society of Nuclear Cardiology published revised appropriate use criteria (AUC) for SPECT MPI in 2009. We assessed adherence to these guidelines and factors associated with inappropriate utilization at the University Medical Center.
  
  
  METHODS
  The AUC was applied retrospectively to 420 SPECT MPI studies. Two-sample t test, Fisher's exact test, and multivariable logistic regression models were used for analysis.
  
  
  RESULTS
  There were 322 appropriate (86%) and 54 (14%) inappropriate studies. The odds of having an inappropriate test increased with younger age (P < .001) and female gender (P < .001). Subjects with diabetes (P = .007) and chest pain (P < .001) were less likely to have an inappropriate test. Academic outpatients were three times more likely to have an inappropriate study (P = .123), while community PCPs were 5.6 times (P = .011) and community cardiologists eight times more likely to order inappropriate tests (P = .031).
  
  
  CONCLUSIONS
  Inappropriate SPECT MPI in low risk younger women is an important issue on the USA-Mexico border. Initiatives to reduce inappropriate SPECT MPI should focus on a few indications and evaluation of cardiovascular symptoms in younger age women in outpatient/community practices.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Emory University, Atlanta, GA, 30322, USA, olalude@emory.edu.
authors.forename: Omosalewa O
authors.initials: OO
authors.lastname: Lalude
authors.forename: Mell F
authors.initials: MF
authors.lastname: Gutarra
authors.forename: Eduardo N
authors.initials: EN
authors.lastname: Pollono
authors.forename: Soyoung
authors.initials: S
authors.lastname: Lee
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Tarwater
mesh_terms: D017677:Age Distribution; D002309:Cardiology / Q000592:standards; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000208:ethnology; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008507:Medically Underserved Area; D008800:Mexico / Q000453:epidemiology; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000592:standards* / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data; D015995:Prevalence; D017678:Sex Distribution; D015899:Tomography, Emission-Computed, Single-Photon / Q000592:standards* / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D019564:Unnecessary Procedures / Q000592:standards / Q000706:statistics & numerical data*; D014600:Utilization Review