Prevalence and clinical characteristics of inappropriate myocardial perfusion imaging tests at a community hospital

Myocardial perfusion imaging (MPI) is a cornerstone for the diagnosis and management of patients with coronary artery disease (CAD). However, the persistence of inappropriate MPI tests as documented by meta-analyses undermines their clinical utility.1 Inappropriate MPI tests reduce diagnostic accuracy and increase false-positive results that can subject patients to unnecessary invasive procedures with additional risks, including radiation exposure, renal insufficiency and bleeding.2 3 Indirect effects at our hospital include prolongation of waiting time for procedures and referrals (currently 5 months for outpatient MPI) and consumption of limited healthcare resources ($350–$500 per test)4 in a predominately uninsured population.5 Inappropriate tests led to more than $500 million of additional costs in 2010 alone.6 To address these challenges, cardiovascular societies promulgated appropriate use criteria (AUC) for MPI, and Congress directed the Centers for Medicare & Medicaid Services to consider AUC in reimbursement decisions.7 Risk calculators that emerged from these efforts are useful to identify appropriate patients who may benefit from MPI tests but remain underused. To investigate the utility of this approach, we evaluated …