title: Impact of Stress Cardiac Magnetic Resonance Imaging on Clinical Care.
abstract: Given the rising costs of imaging, there is increasing pressure to provide evidence for direct additive impact on clinical care. Appropriate use criteria (AUC) were developed to optimize test-patient selection and are increasingly used by payers to assess reimbursement. However, these criteria were created by expert consensus with limited systematic validation. The aims of this study were therefore to determine (1) rates of active clinical change resulting from stress cardiovascular magnetic resonance (CMR) imaging and (2) whether the AUC can predict these changes. We prospectively enrolled 350 consecutive outpatients referred for stress CMR. Categories of "active changes in clinical care" due to stress CMR were predefined. Appropriateness was classified according to the 2013 AUC. Multivariate logistic regression analysis was used to identify factors independently associated with active change. Overall, stress CMR led to an active change in clinical care in about 70% of patients. Rates of change in clinical care did not vary significantly across AUC categories (p = 0.767). In a multivariate model adjusting for clinical variables and AUC, only ischemia (odds ratio [OR] 6.896, 95% CI 2.637 to 18.032, p <0.001), known coronary artery disease (OR 0.300, 95% CI 0.161 to 0.559, p <0.001), and age (OR 0.977, 95% CI 0.954 to 1.000, p = 0.050) independently predicted significant clinical change. In conclusion, stress CMR made a significant impact on clinical management, resulting in active change in clinical care in about 70% of patients. AUC categories were not an independent predictor of clinical change. Clinical change was independently associated with the presence of ischemia, absence of known coronary artery disease, and younger age.
authors.affiliation: Section of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Sloane
authors.initials: S
authors.lastname: McGraw
authors.affiliation: Section of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois; Department of Medicine, University of Verona, Verona, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Romano
authors.affiliation: Section of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Jue
authors.affiliation: Section of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Bauml
authors.affiliation: Section of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Jaehoon
authors.initials: J
authors.lastname: Chung
authors.affiliation: Section of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois; Division of Cardiology, Department of Medicine, Duke University, Durham, North Carolina. Electronic address: afshin@uic.edu.
authors.forename: Afshin
authors.initials: A
authors.lastname: Farzaneh-Far
mesh_terms: D058908:Adenosine A2 Receptor Agonists; D000368:Aged; D000628:Aminophylline; D002316:Cardiotonic Agents; D000066491:Clinical Decision-Making; D003287:Contrast Media; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000628:therapy; D019468:Disease Management; D005080:Exercise Test; D005260:Female; D005682:Gadolinium; D006571:Heterocyclic Compounds; D006801:Humans; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D019028:Magnetic Resonance Imaging, Cine / Q000191:economics / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging* / Q000628:therapy; D055414:Myocardial Perfusion Imaging / Q000191:economics / Q000379:methods*; D016017:Odds Ratio; D009942:Organometallic Compounds; D018579:Patient Selection; D011446:Prospective Studies; D011687:Purines; D011720:Pyrazoles
chemical_list: D058908:Adenosine A2 Receptor Agonists; D002316:Cardiotonic Agents; D003287:Contrast Media; D006571:Heterocyclic Compounds; D009942:Organometallic Compounds; D011687:Purines; D011720:Pyrazoles; C062402:gadoteridol; D000628:Aminophylline; C430916:regadenoson; D005682:Gadolinium