The survey cites a change in the approach to the delivery of cardiovascular care, as well as, continued concerns about economic conditions as reasons for the decline. Specifically, the increasing adoption of Appropriate Use Criteria; higher deductibles and co-pays for those with insurance; increased awareness of radiation optimization; use of provider-based billing by integrated cardiology practices; and an intermittent shortage of Molybdenum-99, were listed as primary reasons for the changes. 

"Nuclear cardiology imaging plays, and will continue to play, an important role diagnosing and treating heart disease," said ASNC President John Mahmarian, MD, FACC.  "Our doctors have been vigilant in prescribing the appropriate use of these tests as defined by our participation in the Choosing Wisely initiative. As health care evolves in the United States, we intend to continue clearly defining the patient-centered approach to cardiovascular imaging and optimizing the value received from it.  Our goal is to continue to provide both quality and value to our patients."