title: Temporal changes in appropriateness of cardiac imaging.
abstract: BACKGROUND
  Appropriate use criteria (AUC) for cardiac imaging have been available for almost 10 years. The extent to which there has been a reported improvement in appropriate use is undefined.
  
  
  OBJECTIVE
  This study systematically reviewed published evidence to identify whether the promulgation of AUC has led to an improvement in the proportion of appropriate cardiac imaging requests.
  
  
  METHODS
  Electronic databases were systematically searched for English-language papers related to AUC and cardiovascular imaging. We found 59 reports involving 103,567 tests that were published from 2000 to 2012. The rate of appropriate testing over time was analyzed in a meta-regression.
  
  
  RESULTS
  New AUC were associated with apparent improvements in appropriateness for transthoracic echocardiography (TTE) (80% [95% confidence interval (CI): 0.75 to 0.84] vs. 85% [95% CI: 0.81 to 0.89]), transesophageal echocardiography (TEE) (89% [95% CI: 0.81 to 0.94] vs. 95% [95% CI: 0.93 to 0.96]) and computed tomography angiography (CTA) (37% [95% CI: 0.21 to 0.55] vs. 55% [95% CI: 0.44 to 0.65]) but not stress echocardiography (53% [95% CI: 0.45 to 0.61] vs. 52% [95% CI: 0.42 to 0.61]) or single-photon emission computed tomography (72% [95% CI: 0.66 to 0.77] vs. 68% [95% CI: 0.60 to 0.74]). Although there were no correlations between the proportion of appropriate TTEs and published year (p = 0.36) for 2007 AUC, there was a positive correlation between proportion of appropriateness and the year of publication (p = 0.01) for 2011 AUC. There was a significant decrease in the proportion of appropriateness over time using the 2007 TEE AUC (p = 0.03) and 2006 CT AUC (p = 0.02). There were no meaningful associations between appropriateness and publication year for stress echocardiography, CTA, or single-photon emission computed tomography.
  
  
  CONCLUSIONS
  Rates of reported appropriate use in imaging show improvements for TTE and CTA but not for stress imaging and TEE. The observed reductions in imaging studies are not matched by reported rates of appropriate use.
authors.affiliation: Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Fonseca
authors.affiliation: Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Negishi
authors.affiliation: Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.
authors.forename: Petr
authors.initials: P
authors.lastname: Otahal
authors.affiliation: Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia. Electronic address: tom.marwick@utas.edu.au.
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Marwick
mesh_terms: D057791:Cardiac Imaging Techniques / Q000145:classification / Q000191:economics; D019983:Guideline Adherence / Q000191:economics / Q000639:trends; D015276:Health Care Rationing; D006331:Heart Diseases / Q000175:diagnosis*; D006801:Humans; D018579:Patient Selection; D010818:Practice Patterns, Physicians' / Q000639:trends
keywords: appropriate use criteria; cardiac imaging; echocardiography; nuclear medicine; tomography