![]() ![]() We searched PubMed (which includes the MEDLINE database and other sources) from Octoto Mafor English-language articles reporting stress echocardiography and radionuclide myocardial perfusion imaging (MPI) appropriateness. Simply stated, we add a more methodologically rigorous meta-analysis to the literature on cardiac imaging appropriateness. While a recent meta-analysis provided important insights into trends in appropriateness across several cardiac imaging modalities, our study differs from this prior work in important ways: we include a greater number of published studies, report a wider range of information about patients characteristics in each study, provide information about indications for inappropriate/rarely appropriate testing, perform more robust analyses of appropriateness by physician specialty (we use both meta-regression and meta-analysis to compare cardiac specialists and internists), and apply a more rigorous method for evaluating temporal trends (we pooled more studies and adjusted for AUC version). We aimed to (1) systematically review studies of cardiac stress testing appropriateness, including appropriateness within physician specialties (2) evaluate trends over time and in response to updates of AUC and (3) characterize leading indications for inappropriate/rarely appropriate testing. However, until recently, little was known about the potential long-term impact of the ACC’s appropriate use criteria on clinical decision-making in patients evaluated for ischemic heart disease. These AUC have expanded to inform the use of a variety of imaging studies and invasive procedures, but cardiac stress testing has been a focal point of attention, largely due to its wide dissemination, radiation risks, procedural risks, expense, and association with downstream testing and procedures-some of which are invasive. ![]() While the Choosing Wisely campaign is perhaps the most widely recognized of these professional efforts to self-regulate use of low-value tests and procedures, it was preceded and informed, in part, by the American College of Cardiology’s (ACC) development of appropriate use criteria (AUC) for cardiac imaging stress tests. Professional society organizations and clinical researchers have also taken steps to better characterize the value of cardiac imaging, while also highlighting clinical scenarios under which imaging use is particularly low-value and unlikely to improve patients’ health or management. Cardiac imaging has advanced physicians’ ability to diagnose and treat a variety of diseases, but rapid growth in the utilization and cost of imaging technology has spurred public and private insurers to scrutinize its use and construct policies aimed at reducing imaging expenditures. ![]()
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