Boster Joshua, Hull Robert, Williams Michael U, Berger Jeremy, Sharp Alec, Fentanes Emilio, Maroules Christopher, Cury Ricardo, Thomas Dustin
Internal Medicine, Brooke Army Medical Center, Fort Sam Houston, USA.
Cardiology, Brooke Army Medical Center, Fort Sam Houston, USA.
Cureus. 2019 Sep 20;11(9):e5708. doi: 10.7759/cureus.5708.
Introduction The coronary artery disease-reporting and data system (CAD-RADS) was developed to standardize communication of per-patient maximal stenosis and provide treatment recommendations that may affect downstream testing. Methods Downstream testing, cardiology referral, and cost were abstracted for 1,796 consecutive patients undergoing coronary CT angiography (CCTA) before and after the adoption of the CAD-RADS reporting template at a single-center closed referral hospital system. Cost analysis was based on direct invasive and non-invasive testing utilizing the Center for Medicare & Medicaid Services (CMS) outpatient prospective payment system (OPPS) final rule for 2018. Results Baseline cardiovascular risk factors were balanced between the groups. Overall, referrals for downstream testing were similar between cohorts (10.7% vs 10.8%; = 0.939). Referral for downstream testing was reduced in the CAD-RADS 1 & 2 cohort compared to non-obstructive coronary artery disease (CAD) by non-standardized reporting (NSR; 5.1% vs 14.4%, < 0.001). This was offset by more non-diagnostic scans in the CAD-RADS cohort (9.7% vs 4.2%, < 0.001), resulting in increased downstream testing (28.8% vs 11.4%, = 0.038). Overall, cardiology referral rates by primary care providers (PCPs) were similar between the groups (12.2% vs 15.8%, = 0.197). Cardiology referral rates were increased among patients with non-obstructive CAD in the NSR cohort compared with CAD-RADS 1 & 2 patients (20.5% vs 8.6%, = 0.021). Referrals for invasive coronary angiography were low in both groups overall (3.5% vs 3.2%, = 0.726). Median downstream testing costs were similar between the groups (= 0.554). Conclusions Adoption of the CAD-RADS reporting template was associated with a reduction in downstream testing and cardiology referral rates among non-obstructive CAD (CAD-RADS 1 & 2) patients. Thus, CAD-RADS may impact downstream testing in patients in whom further testing can typically be deferred.
引言 冠状动脉疾病报告和数据系统（CAD-RADS）的开发旨在规范每位患者最大狭窄程度的沟通，并提供可能影响下游检查的治疗建议。方法 在一个单中心封闭式转诊医院系统中，对采用CAD-RADS报告模板前后连续接受冠状动脉CT血管造影（CCTA）的1796例患者的下游检查、心脏病学转诊和费用进行了提取。费用分析基于利用医疗保险和医疗补助服务中心（CMS）2018年门诊预期支付系统（OPPS）最终规则进行的直接侵入性和非侵入性检查。结果 两组之间的基线心血管危险因素均衡。总体而言，各队列之间下游检查的转诊情况相似（10.7%对10.8%；P=0.939）。与非标准化报告（NSR）的非阻塞性冠状动脉疾病（CAD）相比，CAD-RADS 1和2队列中因下游检查的转诊减少（5.1%对14.4%，P<0.001）。这被CAD-RADS队列中更多的非诊断性扫描所抵消（9.7%对4.2%，P<0.001）,导致下游检查增加（28.8%对11.4%，P=0.038）。总体而言，初级保健提供者（PCP）的心脏病学转诊率在两组之间相似（12.2%对15.8%，P=0.197）。与CAD-RADS 1和2患者相比，NSR队列中非阻塞性CAD患者的心脏病学转诊率增加（20.5%对8.6%，P=0.021）。两组总体上侵入性冠状动脉造影的转诊率都很低（3.5%对3.2%，P=0.726）。两组之间下游检查的中位数费用相似（P=0.554）。结论 采用CAD-RADS报告模板与非阻塞性CAD（CAD-RADS 1和2）患者的下游检查和心脏病学转诊率降低有关。因此，CAD-RADS可能会影响通常可以推迟进一步检查的患者的下游检查。
