Roifman Idan, Austin Peter C, Qiu Feng, Wijeysundera Harindra C
Institute for Clinical Evaluative Sciences (ICES), University of Toronto, Toronto, Ontario, Canada
Schulich Heart Program and the Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
J Am Heart Assoc. 2017 Jun 5;6(6):e005961. doi: 10.1161/JAHA.117.005961.
Concern regarding overutilization of cardiac imaging has led to the development of appropriate use criteria (AUC). Myocardial perfusion imaging (MPI) is one of the most commonly used cardiac imaging modalities worldwide. Despite multiple iterations of AUC, there is currently no evidence regarding their real-world impact on population-based utilization rates of MPI. Our goal was to assess the impact of the AUC on rates of MPI in Ontario, Canada. We hypothesized that publication of the AUC would be associated with a significant reduction in MPI rates.
We conducted a retrospective cohort study of the adult population of Ontario from January 1, 2000, to December 31, 2015. Age- and sex-standardized rates were compared from 4 different periods intersected by 3 published iterations of the AUC. Overall, 3 072 611 MPI scans were performed in Ontario during our study period. The mean monthly rate increased from 14.1/10 000 in the period from January 2000 to October 2005 to 18.2/10 000 between November 2005 and June 2009. After this point in time, there was a reduction in rates, falling to a mean monthly rate of 17.1/10 000 between March 2014 and December 2015. Time series analysis revealed that publication of the 2009 AUC was associated with a significant reduction in MPI rates (<0.001). This translated into ≈88 849 fewer MPI scans at a cost savings of ≈72 million Canadian dollars.
Our results reflect a potential real-world impact of the 2009 MPI AUC by demonstrating evidence of a significant effect on population-based rates of MPI.
对心脏成像过度使用的担忧促使了适当使用标准（AUC）的制定。心肌灌注成像（MPI）是全球最常用的心脏成像方式之一。尽管AUC已经多次修订，但目前尚无证据表明其对基于人群的MPI使用率有实际影响。我们的目标是评估AUC对加拿大安大略省MPI使用率的影响。我们假设AUC的发布将与MPI使用率的显著降低相关。
我们对2000年1月1日至2015年12月31日安大略省的成年人口进行了一项回顾性队列研究。比较了由AUC的3次发布迭代所划分的4个不同时期的年龄和性别标准化率。在我们的研究期间，安大略省共进行了3072611次MPI扫描。平均月率从2000年1月至2005年10月期间的14.1/10000增加到2005年11月至2009年6月期间的18.2/10000。在此时间点之后，使用率有所下降，在2014年3月至2015年12月期间降至平均月率17.1/10000。时间序列分析显示，2009年AUC的发布与MPI使用率的显著降低相关（<0.001）。这意味着MPI扫描减少了约88849次，节省了约7200万加元的成本。
我们的结果通过证明对基于人群的MPI率有显著影响的证据，反映了2009年MPI AUC的潜在实际影响。
