New Study Evaluates Trends in Cardiac Stress Testing After Coronary Stenting

Modest reductions in the use of stress testing from 2006 to 2008 were not associated with any single testing modality but may be related to efforts by insurance companies to reduce the use of stress testing and to the development of appropriate use criteria (AUC), according to a new study published on Oct. 8 in the Journal of the American College of Cardiology: Cardiovascular Imaging.

Evaluating trends in the use of cardiac stress testing after percutaneous coronary stenting procedures among 284,971 Medicare patients age 65 years and older in the ACC's NCDR® CathPCI Registry®, the study found that the overall stress testing rate following coronary stenting was 53.1 per 100 person-years, and that the rates declined from 59.3 in 2006 to 47.1 in 2008. However, the use of testing modalities changed little in the same period.

The analysis also found that the rate of electrocardiography-only exercise stress testing varied across geographic census divisions from 6.8 percent to 22.8 percent. Among the patients who also received an imaging test, the proportion who received echocardiography vs. nuclear testing varied across geographic census divisions from 9.4 to 34.1 percent. In addition, electrocardiography-only exercise stress testing was associated with more post-test stress testing but less catheterization than image-based stress tests.

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The study's authors concluded that geographic variations in the stress testing modalities used and differences in post-test procedures suggest a need for research to identify the optimal use of different stress test methods in individual patients. The authors note that further research is necessary to determine whether the trend toward reductions in the use of cardiac stress testing found in this study represents better patient selection or restricted access to testing.

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