title: Underutilization of Coronary Artery Disease Testing Among Patients Hospitalized With New-Onset Heart Failure.
abstract: Although ischemic coronary artery disease (CAD) is the most common etiology of heart failure (HF), the extent to which patients with new-onset HF actually undergo an ischemic work-up and/or revascularization is not well defined.
  
  
  
  This study sought to analyze the patterns of testing for ischemic CAD and revascularization in patients with new-onset HF.
  
  
  
  This was a retrospective cohort study using Truven Health MarketScan Commercial and Medicare databases from 2010 to 2013. The occurrence of noninvasive and invasive ischemic CAD testing and revascularization procedures were examined among patients with new inpatient HF diagnoses during the index hospitalization and within 90 days of admission.
  
  
  
  Among 67,161 patients identified with new-onset HF during an inpatient hospitalization, only 17.5% underwent testing for ischemic CAD during the index hospitalization, increasing to 27.4% at 90 days. Among patients with new-onset HF, only 2.1% underwent revascularization during the index hospitalization for HF; by 90 days, the revascularization rate had increased to 4.3%. Of the tests performed for ischemic CAD, stress testing (nuclear stress testing or stress echocardiography) was performed in 7.9% of new-onset HF patients during the index hospitalization (14.6% within 90 days), whereas coronary angiography was performed in 11.1% of patients during the index hospitalization (16.5% within 90 days). In adjusted analyses, HF patients carrying a baseline diagnosis of CAD had greater odds of noninvasive ischemic testing (odds ratio: 1.25; 95% confidence interval: 1.17 to 1.33; p < 0.0001), as well as invasive ischemic testing (odds ratio: 1.93; 95% confidence interval: 1.83 to 2.05; p < 0.0001), at the index hospitalization than those without baseline CAD.
  
  
  
  The majority of patients hospitalized for new-onset HF did not receive testing for ischemic CAD either during hospitalization or within 90 days, which suggests significant underutilization of ischemic CAD assessment in new-onset HF patients.
authors.affiliation: Division of Cardiology, Columbia University Medical Center/New York-Presbyterian Hospital, New York, New York.
authors.forename: Darshan
authors.initials: D
authors.lastname: Doshi
authors.affiliation: Division of Cardiology, Columbia University Medical Center/New York-Presbyterian Hospital, New York, New York; Cardiovascular Research Foundation, New York, New York.
authors.forename: Ori
authors.initials: O
authors.lastname: Ben-Yehuda
authors.affiliation: Truven Health Analytics, Cambridge, Massachusetts.
authors.forename: Machaon
authors.initials: M
authors.lastname: Bonafede
authors.affiliation: Massachusetts Institute of Technology, Cambridge, Massachusetts; Abiomed Inc., Danvers, Massachusetts.
authors.forename: Noam
authors.initials: N
authors.lastname: Josephy
authors.affiliation: Division of Cardiology, Columbia University Medical Center/New York-Presbyterian Hospital, New York, New York; Cardiovascular Research Foundation, New York, New York.
authors.forename: Dimitri
authors.initials: D
authors.lastname: Karmpaliotis
authors.affiliation: Division of Cardiology, Columbia University Medical Center/New York-Presbyterian Hospital, New York, New York.
authors.forename: Manish A
authors.initials: MA
authors.lastname: Parikh
authors.affiliation: Division of Cardiology, Columbia University Medical Center/New York-Presbyterian Hospital, New York, New York; Cardiovascular Research Foundation, New York, New York.
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Moses
authors.affiliation: Division of Cardiology, Columbia University Medical Center/New York-Presbyterian Hospital, New York, New York; Cardiovascular Research Foundation, New York, New York.
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
authors.affiliation: Division of Cardiology, Columbia University Medical Center/New York-Presbyterian Hospital, New York, New York; Cardiovascular Research Foundation, New York, New York.
authors.forename: Martin B
authors.initials: MB
authors.lastname: Leon
authors.affiliation: Division of Cardiology, Columbia University Medical Center/New York-Presbyterian Hospital, New York, New York.
authors.forename: Allan
authors.initials: A
authors.lastname: Schwartz
authors.affiliation: Division of Cardiology, Columbia University Medical Center/New York-Presbyterian Hospital, New York, New York; Cardiovascular Research Foundation, New York, New York. Electronic address: akirtane@columbia.edu.
authors.forename: Ajay J
authors.initials: AJ
authors.lastname: Kirtane
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis*; D025401:Echocardiography, Stress / Q000706:statistics & numerical data*; D005080:Exercise Test / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D008297:Male; D012189:Retrospective Studies
keywords: angiography; invasive; ischemic CAD; noninvasive; revascularization; stress testing