title: Cardiac Stress Test Trends Among US Patients Younger Than 65 Years, 2005-2012.
abstract: OBJECTIVE
  After a period of rapid growth, use of cardiac stress testing has recently decreased among Medicare beneficiaries and in a large integrated health system. However, it is not known whether declines in cardiac stress testing are universal or are confined to certain populations.
  
  
  OBJECTIVE
  To determine trends in rates of cardiac stress testing among a large and diverse cohort of commercially insured patients.
  
  
  METHODS
  A serial cross-sectional study with time trends was conducted using administrative claims from all members aged 25 to 64 years belonging to a large, national managed care company from January 1, 2005, to December 31, 2012. Linear trends in rates were determined using negative binomial regression models with procedure count as the dependent variable, calendar quarter as the key independent variable, and the size of the population as a logged offset term. Data analysis was performed from January 1, 2005, to December 31, 2012.
  
  
  METHODS
  Age- and sex-adjusted rates of cardiac stress tests per calendar quarter (reported as number of tests per 100 000 person-years).
  
  
  RESULTS
  A total of 2 085 591 cardiac stress tests were performed among 32 921 838 persons (mean [SD] age, 43.2 [10.9] years; 16 625 528 women [50.5%] and 16 296 310 [49.5%] men; 7 604 945 nonwhite [23.1%]). There was a 3.0% increase in rates of cardiac stress testing from 2005 (3486 tests; 95% CI, 3458-3514) to 2012 (3589 tests; 95% CI, 3559-3619; P = .01 for linear trend). Use of nuclear single-photon emission computed tomography decreased by 14.9% from 2005 (1907 tests; 95% CI, 1888-1926) to 2012 (1623 tests; 95% CI, 1603-1643; P = .03). Use of stress echocardiography increased by 27.8% from 2005 (709 tests; 95% CI, 697-721) to 2012 (906 tests; 95% CI, 894 to 920; P < .001). Use of exercise electrocardiography increased by 12.5% from 2005 (861 tests; 95% CI, 847-873) to 2012 (969 tests; 95% CI, 953-985; P < .001). Use of other stress testing modalities increased 65.5% from 2006 (55 tests; 95% CI, 51-59) to 2012 (91 tests; 95% CI, 87-95; P < .001). For individuals aged 25 to 34 years, rates of cardiac stress testing increased 59.1% from 2005 (543 tests; 95% CI, 532-554) to 2012 (864 tests; 95% CI, 852-876; P < .001). For individuals aged 55 to 64 years, rates of cardiac stress testing decreased by 12.3% from 2005 (7894 tests; 95% CI, 7820-7968) to 2012 (6923 tests; 95% CI, 6853-6993; P < .001).
  
  
  CONCLUSIONS
  In contrast to declines in the use of cardiac stress testing in some health care systems, we observed a small increase in its use among a nationally representative cohort of commercially insured patients. Our findings suggest that observed trends in the use of cardiac stress testing may have been driven more by unique characteristics of populations and health systems than national efforts to reduce the overuse of testing.
authors.affiliation: Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia2The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia.
authors.forename: Vinay
authors.initials: V
authors.lastname: Kini
authors.affiliation: The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia3Division of Cardiac Surgery, Hospital of the University of Pennsylvania, Philadelphia.
authors.forename: Fenton H
authors.initials: FH
authors.lastname: McCarthy
authors.affiliation: Division of General Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia.
authors.forename: Elias
authors.initials: E
authors.lastname: Dayoub
authors.affiliation: Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Denver6Division of Cardiovascular Medicine, Veterans Affairs Eastern Colorado Health Care System, Denver.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Bradley
authors.affiliation: Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Denver.
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Masoudi
authors.affiliation: Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Denver6Division of Cardiovascular Medicine, Veterans Affairs Eastern Colorado Health Care System, Denver.
authors.forename: P Michael
authors.initials: PM
authors.lastname: Ho
authors.affiliation: The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia4Division of General Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia.
authors.forename: Peter W
authors.initials: PW
authors.lastname: Groeneveld