User login
SAN FRANCISCO – A new report compiled by eight cardiology and imaging specialty organizations updates 4-year-old recommendations on when to use (or not use) cardiac CT imaging.
The eight societies hope that the recommendations not only will help inform clinicians and patients who are considering cardiac CT but will also guide insurers and third-party payers in setting rational reimbursement policies for cardiac CT.
The report, released by the American College of Cardiology, was endorsed by the ACC Foundation, the Society of Cardiovascular Computed Tomography, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the American Society of Nuclear Cardiology, the Society for Cardiovascular Angiography and Interventions, and the Society for Cardiovascular Magnetic Resonance.
The full report was published online Oct. 25 in the Journal of the American College of Cardiology, and is available at www.cardiosource.org. It will also be published in Circulation and in the Journal of Cardiovascular Computed Tomography.
The appropriate use criteria cover two tests: cardiac CT angiography using contrast, x-ray, or dye; and noncontrast CT scanning for calcium scoring, used to detect calcium deposits in the arteries.
In general, CT angiography was considered appropriate for diagnosis and risk assessment in patients with symptoms of possible heart disease who have a low to intermediate risk of a heart problem, or in situations where the diagnosis of heart disease is uncertain after other tests are performed.
Calcium scanning was considered appropriate in patients without heart symptoms who have an intermediate risk of heart disease, or in selected patients with low risk (especially women or younger men) with a family history of heart problems.
Cardiac CT would not be appropriate for general screening in asymptomatic patients, or in patients with known heart problems or a high risk for heart disease, or for routine repeat testing, the report concludes. Adding the test when patients have high risk for heart disease or existing heart problems does not add any useful clinical information, said Dr. Allen J. Taylor in a statement released by the ACC. Dr. Taylor is chair of the report’s writing committee and professor of medicine at Georgetown University, Washington.
The report also judged the usefulness of cardiac CT to be “uncertain” in some clinical scenarios, and the authors emphasized repeatedly that this does not mean that the test is inappropriate or that insurers should not reimburse for its use in these situations. An “uncertain” indication may require individual physician judgment and understanding of the patient to decide whether cardiac CT might help.
Tables in the report list 60 indications deemed to be appropriate, 52 rated as uncertain, and 55 indications that were considered inappropriate for cardiac CT. Clinical scenarios included acute and chronic chest pain, testing in symptomatic and asymptomatic patients, heart failure, preoperative risk assessment before either cardiac or noncardiac surgery, testing in the setting of prior test results (such as exercise testing, stress imaging procedures, or coronary calcium scores), prior revascularization, and evaluation of cardiac structure and function.
The document replaces the original 2006 criteria that were created when cardiac CT was relatively new (J. Am. Coll. Cardiol. 2006;48:1475-97).
The process that was used to create the new criteria combined evidence-based medicine and practice experience. A seven-member writing group developed clinical scenarios that were scored by a 19-member technical panel on a 1-9 scale to reflect their judgments of appropriate use of cardiac CT, inappropriate use, or uncertainty about the appropriateness of use.
In the real world, no physicians or facilities will have 100% of their cardiac CT procedure fall within the “appropriate” indications, the report notes. But if a physician or facility has a higher rate of inappropriate procedures than the national average, they may want to examine their patterns of care.
For the first time, the report considered CT angiography in patients with heart failure and normal, as well as abnormal, left ventricular ejection fraction (LVEF), with ratings of appropriate or uncertain. The only appropriate scenarios covered patients with reduced LVEF who had low or intermediate pretest probability of coronary artery disease.
CT angiography was considered a potential option as part of preoperative evaluations for patients undergoing heart surgery for noncoronary indications such as valve replacement, and was considered appropriate in patients with intermediate pretest risk for coronary artery disease, and of uncertain appropriateness if the pretest risk was low. Coronary CT angiography was never considered appropriate for evaluations before noncardiac surgery.
Imaging for evaluation of left main coronary stents was deemed appropriate, and was considered uncertain for any coronary stents measuring 3 mm in diameter or larger that had been in place at least 2 years.
The evaluation of cardiac structure and function is considered a strength of cardiac CT imaging. For the first time, the report rated cardiac CT as appropriate in patients with suspected arrhythmogenic right ventricular dysplasia, and as uncertain for evaluation of myocardial viability when other imaging modalities are inadequate or contraindicated.
Using cardiac CT before electrophysiologic procedures for anatomical mapping, or prior to repeat sternotomy in reoperative cardiac surgery, also was rated appropriate.
Disagreement among panelists over two clinical scenarios in particular left these two in the uncertain category: using cardiac CT to detect coronary artery disease in patients with a low probability of coronary artery disease when the ECG is interpretable and the patient is able to exercise, and using cardiac CT for coronary assessment prior to noncoronary cardiac surgery in patients with a low probability for coronary artery disease.
The report attempts to align its language and definitions with those in the ACC’s 2009 appropriate use criteria for cardiac radionuclide imaging (J. Am. Coll. Cardiol. 2009;53:2201-29).
Besides considering appropriate use of cardiac CT, clinicians should consider balancing the use of radiation dose–reduction techniques with the preservation of image quality, the report notes. A separate 2010 expert consensus document addressed issues of balancing those competing demands (J. Am. Coll. Cardiol. 2010;55:2663-99).
Creation of the report was funded by the American College of Cardiology Foundation and by the other professional societies. Dr. Taylor reported having no pertinent conflicts of interest. He has been a consultant to Abbott Laboratories and has received research funds form Abbott and Resverlogix Corp. Others on the writing or technical committees and a panel of reviewers involved in the report declared potential conflicts of interest that are listed in the report.
Dr. Rita F. Redberg: Cardiac CT Not Proven Useful
There aren’t any clinical trial data to suggest any benefit to use of cardiac CT in terms of clinical outcomes. The report’s authors didn’t spend a lot of time on the data. They spent a lot of time on various scenarios. There certainly are small studies that have looked at selected populations and the sensitivity and specificity of cardiac CT in those populations. And there are some clinical trials that are now starting to recruit participants. I think we’ll have results in a few years from those, but at this time, we have no outcomes data.
Cardiac CT is being used more, and so they’re trying to put out guidance for it. There are certainly a lot of CT scanners around. That does drive its use.
I’m really driven a lot more by evidence and clinical trials than by reading this report. I don’t think it will change my practice.
Any potential effect on reimbursements depends on the insurer’s criteria. A lot of insurers look for evidence as well. The ACC and the Society of Cardiovascular Computed Tomography are making a good faith effort to give guidance in this area, but I think that in the absence of data, it’s best to wait until the data are collected. There’s no big rush to start doing CT. We have ways to diagnose heart disease that work pretty well. There are no data suggesting that cardiac CT is a better way. There are risks to CT. There’s certainly a lot of radiation, there’s contrast, and dye. I think it’s prudent to wait for the data showing that this is good for patients before changing my practice.
The appropriate-use criteria is a good process, but I think that, like any process, it needs to be driven by evidence. Evidence is certainly accumulating, but we’re not there yet. I think we’re looking at another few years before we’ll really have outcomes data for cardiac CT.
Rita F. Redberg, M.D. is a professor of cardiology at the University of California, San Francisco who was not involved in the 2010 report but was involved in the 2006 report. She provided these comments in a phone interview, and said she has no pertinent conflicts of interest.
|
At our institution, we will be incorporating the new practices and sharing them with our referring physicians. We will be advocating more calcium scoring in asymptomatic intermediate-risk patients, as this indication is now considered appropriate based upon more available science and validation studies. In addition, the criteria expand to stents and bypass grafts, and this will open doors for patients and clinicians to expand their practice and increase this tool as an important part of their imaging armamentarium.
Cardiologists will continue to increase their use of cardiac CT because of the very high negative predictive power of cardiac CT, whereby a negative test effectively rules out obstructive coronary artery disease. This obviates the need in these cases for the more expensive options of both nuclear imaging and invasive angiography. Using cardiac CT first (or early) in the course of patient management has been shown to be a more cost-effective algorithm for patient treatment. Large HMOs like Kaiser are also incorporating cardiac CT into their practices, expediting cardiac work-ups with a more accurate and less expensive test.
I think this report certainly helps the case for reimbursement, since many radiology benefit managers who control approvals for certain payers (such as Blue Cross/Blue Shield) can incorporate these criteria into their approval process. These criteria are specific for different cases and presentations, so it is very pertinent to payers who can choose to pay for these specific cases.
Matthew J. Budoff, M.D., is president of the Society of Cardiovascular Computed Tomography, which helped develop the report. He is a professor of medicine at the University of California, Los Angeles, and director of cardiac CT at Harbor-UCLA Medical Center, Torrance, Calif. Dr. Budoff has been a speaker for General Electric and an expert witness in CT scanning.
|
At our institution, we will be incorporating the new practices and sharing them with our referring physicians. We will be advocating more calcium scoring in asymptomatic intermediate-risk patients, as this indication is now considered appropriate based upon more available science and validation studies. In addition, the criteria expand to stents and bypass grafts, and this will open doors for patients and clinicians to expand their practice and increase this tool as an important part of their imaging armamentarium.
Cardiologists will continue to increase their use of cardiac CT because of the very high negative predictive power of cardiac CT, whereby a negative test effectively rules out obstructive coronary artery disease. This obviates the need in these cases for the more expensive options of both nuclear imaging and invasive angiography. Using cardiac CT first (or early) in the course of patient management has been shown to be a more cost-effective algorithm for patient treatment. Large HMOs like Kaiser are also incorporating cardiac CT into their practices, expediting cardiac work-ups with a more accurate and less expensive test.
I think this report certainly helps the case for reimbursement, since many radiology benefit managers who control approvals for certain payers (such as Blue Cross/Blue Shield) can incorporate these criteria into their approval process. These criteria are specific for different cases and presentations, so it is very pertinent to payers who can choose to pay for these specific cases.
Matthew J. Budoff, M.D., is president of the Society of Cardiovascular Computed Tomography, which helped develop the report. He is a professor of medicine at the University of California, Los Angeles, and director of cardiac CT at Harbor-UCLA Medical Center, Torrance, Calif. Dr. Budoff has been a speaker for General Electric and an expert witness in CT scanning.
|
At our institution, we will be incorporating the new practices and sharing them with our referring physicians. We will be advocating more calcium scoring in asymptomatic intermediate-risk patients, as this indication is now considered appropriate based upon more available science and validation studies. In addition, the criteria expand to stents and bypass grafts, and this will open doors for patients and clinicians to expand their practice and increase this tool as an important part of their imaging armamentarium.
Cardiologists will continue to increase their use of cardiac CT because of the very high negative predictive power of cardiac CT, whereby a negative test effectively rules out obstructive coronary artery disease. This obviates the need in these cases for the more expensive options of both nuclear imaging and invasive angiography. Using cardiac CT first (or early) in the course of patient management has been shown to be a more cost-effective algorithm for patient treatment. Large HMOs like Kaiser are also incorporating cardiac CT into their practices, expediting cardiac work-ups with a more accurate and less expensive test.
I think this report certainly helps the case for reimbursement, since many radiology benefit managers who control approvals for certain payers (such as Blue Cross/Blue Shield) can incorporate these criteria into their approval process. These criteria are specific for different cases and presentations, so it is very pertinent to payers who can choose to pay for these specific cases.
Matthew J. Budoff, M.D., is president of the Society of Cardiovascular Computed Tomography, which helped develop the report. He is a professor of medicine at the University of California, Los Angeles, and director of cardiac CT at Harbor-UCLA Medical Center, Torrance, Calif. Dr. Budoff has been a speaker for General Electric and an expert witness in CT scanning.
SAN FRANCISCO – A new report compiled by eight cardiology and imaging specialty organizations updates 4-year-old recommendations on when to use (or not use) cardiac CT imaging.
The eight societies hope that the recommendations not only will help inform clinicians and patients who are considering cardiac CT but will also guide insurers and third-party payers in setting rational reimbursement policies for cardiac CT.
The report, released by the American College of Cardiology, was endorsed by the ACC Foundation, the Society of Cardiovascular Computed Tomography, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the American Society of Nuclear Cardiology, the Society for Cardiovascular Angiography and Interventions, and the Society for Cardiovascular Magnetic Resonance.
The full report was published online Oct. 25 in the Journal of the American College of Cardiology, and is available at www.cardiosource.org. It will also be published in Circulation and in the Journal of Cardiovascular Computed Tomography.
The appropriate use criteria cover two tests: cardiac CT angiography using contrast, x-ray, or dye; and noncontrast CT scanning for calcium scoring, used to detect calcium deposits in the arteries.
In general, CT angiography was considered appropriate for diagnosis and risk assessment in patients with symptoms of possible heart disease who have a low to intermediate risk of a heart problem, or in situations where the diagnosis of heart disease is uncertain after other tests are performed.
Calcium scanning was considered appropriate in patients without heart symptoms who have an intermediate risk of heart disease, or in selected patients with low risk (especially women or younger men) with a family history of heart problems.
Cardiac CT would not be appropriate for general screening in asymptomatic patients, or in patients with known heart problems or a high risk for heart disease, or for routine repeat testing, the report concludes. Adding the test when patients have high risk for heart disease or existing heart problems does not add any useful clinical information, said Dr. Allen J. Taylor in a statement released by the ACC. Dr. Taylor is chair of the report’s writing committee and professor of medicine at Georgetown University, Washington.
The report also judged the usefulness of cardiac CT to be “uncertain” in some clinical scenarios, and the authors emphasized repeatedly that this does not mean that the test is inappropriate or that insurers should not reimburse for its use in these situations. An “uncertain” indication may require individual physician judgment and understanding of the patient to decide whether cardiac CT might help.
Tables in the report list 60 indications deemed to be appropriate, 52 rated as uncertain, and 55 indications that were considered inappropriate for cardiac CT. Clinical scenarios included acute and chronic chest pain, testing in symptomatic and asymptomatic patients, heart failure, preoperative risk assessment before either cardiac or noncardiac surgery, testing in the setting of prior test results (such as exercise testing, stress imaging procedures, or coronary calcium scores), prior revascularization, and evaluation of cardiac structure and function.
The document replaces the original 2006 criteria that were created when cardiac CT was relatively new (J. Am. Coll. Cardiol. 2006;48:1475-97).
The process that was used to create the new criteria combined evidence-based medicine and practice experience. A seven-member writing group developed clinical scenarios that were scored by a 19-member technical panel on a 1-9 scale to reflect their judgments of appropriate use of cardiac CT, inappropriate use, or uncertainty about the appropriateness of use.
In the real world, no physicians or facilities will have 100% of their cardiac CT procedure fall within the “appropriate” indications, the report notes. But if a physician or facility has a higher rate of inappropriate procedures than the national average, they may want to examine their patterns of care.
For the first time, the report considered CT angiography in patients with heart failure and normal, as well as abnormal, left ventricular ejection fraction (LVEF), with ratings of appropriate or uncertain. The only appropriate scenarios covered patients with reduced LVEF who had low or intermediate pretest probability of coronary artery disease.
CT angiography was considered a potential option as part of preoperative evaluations for patients undergoing heart surgery for noncoronary indications such as valve replacement, and was considered appropriate in patients with intermediate pretest risk for coronary artery disease, and of uncertain appropriateness if the pretest risk was low. Coronary CT angiography was never considered appropriate for evaluations before noncardiac surgery.
Imaging for evaluation of left main coronary stents was deemed appropriate, and was considered uncertain for any coronary stents measuring 3 mm in diameter or larger that had been in place at least 2 years.
The evaluation of cardiac structure and function is considered a strength of cardiac CT imaging. For the first time, the report rated cardiac CT as appropriate in patients with suspected arrhythmogenic right ventricular dysplasia, and as uncertain for evaluation of myocardial viability when other imaging modalities are inadequate or contraindicated.
Using cardiac CT before electrophysiologic procedures for anatomical mapping, or prior to repeat sternotomy in reoperative cardiac surgery, also was rated appropriate.
Disagreement among panelists over two clinical scenarios in particular left these two in the uncertain category: using cardiac CT to detect coronary artery disease in patients with a low probability of coronary artery disease when the ECG is interpretable and the patient is able to exercise, and using cardiac CT for coronary assessment prior to noncoronary cardiac surgery in patients with a low probability for coronary artery disease.
The report attempts to align its language and definitions with those in the ACC’s 2009 appropriate use criteria for cardiac radionuclide imaging (J. Am. Coll. Cardiol. 2009;53:2201-29).
Besides considering appropriate use of cardiac CT, clinicians should consider balancing the use of radiation dose–reduction techniques with the preservation of image quality, the report notes. A separate 2010 expert consensus document addressed issues of balancing those competing demands (J. Am. Coll. Cardiol. 2010;55:2663-99).
Creation of the report was funded by the American College of Cardiology Foundation and by the other professional societies. Dr. Taylor reported having no pertinent conflicts of interest. He has been a consultant to Abbott Laboratories and has received research funds form Abbott and Resverlogix Corp. Others on the writing or technical committees and a panel of reviewers involved in the report declared potential conflicts of interest that are listed in the report.
Dr. Rita F. Redberg: Cardiac CT Not Proven Useful
There aren’t any clinical trial data to suggest any benefit to use of cardiac CT in terms of clinical outcomes. The report’s authors didn’t spend a lot of time on the data. They spent a lot of time on various scenarios. There certainly are small studies that have looked at selected populations and the sensitivity and specificity of cardiac CT in those populations. And there are some clinical trials that are now starting to recruit participants. I think we’ll have results in a few years from those, but at this time, we have no outcomes data.
Cardiac CT is being used more, and so they’re trying to put out guidance for it. There are certainly a lot of CT scanners around. That does drive its use.
I’m really driven a lot more by evidence and clinical trials than by reading this report. I don’t think it will change my practice.
Any potential effect on reimbursements depends on the insurer’s criteria. A lot of insurers look for evidence as well. The ACC and the Society of Cardiovascular Computed Tomography are making a good faith effort to give guidance in this area, but I think that in the absence of data, it’s best to wait until the data are collected. There’s no big rush to start doing CT. We have ways to diagnose heart disease that work pretty well. There are no data suggesting that cardiac CT is a better way. There are risks to CT. There’s certainly a lot of radiation, there’s contrast, and dye. I think it’s prudent to wait for the data showing that this is good for patients before changing my practice.
The appropriate-use criteria is a good process, but I think that, like any process, it needs to be driven by evidence. Evidence is certainly accumulating, but we’re not there yet. I think we’re looking at another few years before we’ll really have outcomes data for cardiac CT.
Rita F. Redberg, M.D. is a professor of cardiology at the University of California, San Francisco who was not involved in the 2010 report but was involved in the 2006 report. She provided these comments in a phone interview, and said she has no pertinent conflicts of interest.
SAN FRANCISCO – A new report compiled by eight cardiology and imaging specialty organizations updates 4-year-old recommendations on when to use (or not use) cardiac CT imaging.
The eight societies hope that the recommendations not only will help inform clinicians and patients who are considering cardiac CT but will also guide insurers and third-party payers in setting rational reimbursement policies for cardiac CT.
The report, released by the American College of Cardiology, was endorsed by the ACC Foundation, the Society of Cardiovascular Computed Tomography, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the American Society of Nuclear Cardiology, the Society for Cardiovascular Angiography and Interventions, and the Society for Cardiovascular Magnetic Resonance.
The full report was published online Oct. 25 in the Journal of the American College of Cardiology, and is available at www.cardiosource.org. It will also be published in Circulation and in the Journal of Cardiovascular Computed Tomography.
The appropriate use criteria cover two tests: cardiac CT angiography using contrast, x-ray, or dye; and noncontrast CT scanning for calcium scoring, used to detect calcium deposits in the arteries.
In general, CT angiography was considered appropriate for diagnosis and risk assessment in patients with symptoms of possible heart disease who have a low to intermediate risk of a heart problem, or in situations where the diagnosis of heart disease is uncertain after other tests are performed.
Calcium scanning was considered appropriate in patients without heart symptoms who have an intermediate risk of heart disease, or in selected patients with low risk (especially women or younger men) with a family history of heart problems.
Cardiac CT would not be appropriate for general screening in asymptomatic patients, or in patients with known heart problems or a high risk for heart disease, or for routine repeat testing, the report concludes. Adding the test when patients have high risk for heart disease or existing heart problems does not add any useful clinical information, said Dr. Allen J. Taylor in a statement released by the ACC. Dr. Taylor is chair of the report’s writing committee and professor of medicine at Georgetown University, Washington.
The report also judged the usefulness of cardiac CT to be “uncertain” in some clinical scenarios, and the authors emphasized repeatedly that this does not mean that the test is inappropriate or that insurers should not reimburse for its use in these situations. An “uncertain” indication may require individual physician judgment and understanding of the patient to decide whether cardiac CT might help.
Tables in the report list 60 indications deemed to be appropriate, 52 rated as uncertain, and 55 indications that were considered inappropriate for cardiac CT. Clinical scenarios included acute and chronic chest pain, testing in symptomatic and asymptomatic patients, heart failure, preoperative risk assessment before either cardiac or noncardiac surgery, testing in the setting of prior test results (such as exercise testing, stress imaging procedures, or coronary calcium scores), prior revascularization, and evaluation of cardiac structure and function.
The document replaces the original 2006 criteria that were created when cardiac CT was relatively new (J. Am. Coll. Cardiol. 2006;48:1475-97).
The process that was used to create the new criteria combined evidence-based medicine and practice experience. A seven-member writing group developed clinical scenarios that were scored by a 19-member technical panel on a 1-9 scale to reflect their judgments of appropriate use of cardiac CT, inappropriate use, or uncertainty about the appropriateness of use.
In the real world, no physicians or facilities will have 100% of their cardiac CT procedure fall within the “appropriate” indications, the report notes. But if a physician or facility has a higher rate of inappropriate procedures than the national average, they may want to examine their patterns of care.
For the first time, the report considered CT angiography in patients with heart failure and normal, as well as abnormal, left ventricular ejection fraction (LVEF), with ratings of appropriate or uncertain. The only appropriate scenarios covered patients with reduced LVEF who had low or intermediate pretest probability of coronary artery disease.
CT angiography was considered a potential option as part of preoperative evaluations for patients undergoing heart surgery for noncoronary indications such as valve replacement, and was considered appropriate in patients with intermediate pretest risk for coronary artery disease, and of uncertain appropriateness if the pretest risk was low. Coronary CT angiography was never considered appropriate for evaluations before noncardiac surgery.
Imaging for evaluation of left main coronary stents was deemed appropriate, and was considered uncertain for any coronary stents measuring 3 mm in diameter or larger that had been in place at least 2 years.
The evaluation of cardiac structure and function is considered a strength of cardiac CT imaging. For the first time, the report rated cardiac CT as appropriate in patients with suspected arrhythmogenic right ventricular dysplasia, and as uncertain for evaluation of myocardial viability when other imaging modalities are inadequate or contraindicated.
Using cardiac CT before electrophysiologic procedures for anatomical mapping, or prior to repeat sternotomy in reoperative cardiac surgery, also was rated appropriate.
Disagreement among panelists over two clinical scenarios in particular left these two in the uncertain category: using cardiac CT to detect coronary artery disease in patients with a low probability of coronary artery disease when the ECG is interpretable and the patient is able to exercise, and using cardiac CT for coronary assessment prior to noncoronary cardiac surgery in patients with a low probability for coronary artery disease.
The report attempts to align its language and definitions with those in the ACC’s 2009 appropriate use criteria for cardiac radionuclide imaging (J. Am. Coll. Cardiol. 2009;53:2201-29).
Besides considering appropriate use of cardiac CT, clinicians should consider balancing the use of radiation dose–reduction techniques with the preservation of image quality, the report notes. A separate 2010 expert consensus document addressed issues of balancing those competing demands (J. Am. Coll. Cardiol. 2010;55:2663-99).
Creation of the report was funded by the American College of Cardiology Foundation and by the other professional societies. Dr. Taylor reported having no pertinent conflicts of interest. He has been a consultant to Abbott Laboratories and has received research funds form Abbott and Resverlogix Corp. Others on the writing or technical committees and a panel of reviewers involved in the report declared potential conflicts of interest that are listed in the report.
Dr. Rita F. Redberg: Cardiac CT Not Proven Useful
There aren’t any clinical trial data to suggest any benefit to use of cardiac CT in terms of clinical outcomes. The report’s authors didn’t spend a lot of time on the data. They spent a lot of time on various scenarios. There certainly are small studies that have looked at selected populations and the sensitivity and specificity of cardiac CT in those populations. And there are some clinical trials that are now starting to recruit participants. I think we’ll have results in a few years from those, but at this time, we have no outcomes data.
Cardiac CT is being used more, and so they’re trying to put out guidance for it. There are certainly a lot of CT scanners around. That does drive its use.
I’m really driven a lot more by evidence and clinical trials than by reading this report. I don’t think it will change my practice.
Any potential effect on reimbursements depends on the insurer’s criteria. A lot of insurers look for evidence as well. The ACC and the Society of Cardiovascular Computed Tomography are making a good faith effort to give guidance in this area, but I think that in the absence of data, it’s best to wait until the data are collected. There’s no big rush to start doing CT. We have ways to diagnose heart disease that work pretty well. There are no data suggesting that cardiac CT is a better way. There are risks to CT. There’s certainly a lot of radiation, there’s contrast, and dye. I think it’s prudent to wait for the data showing that this is good for patients before changing my practice.
The appropriate-use criteria is a good process, but I think that, like any process, it needs to be driven by evidence. Evidence is certainly accumulating, but we’re not there yet. I think we’re looking at another few years before we’ll really have outcomes data for cardiac CT.
Rita F. Redberg, M.D. is a professor of cardiology at the University of California, San Francisco who was not involved in the 2010 report but was involved in the 2006 report. She provided these comments in a phone interview, and said she has no pertinent conflicts of interest.