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Impact of choice of imaging modality accompanying outpatient exercise stress testing on outcomes and resource use after revascularization for acute coronary syndromes.

Publication ,  Journal Article
Federspiel, JJ; Shah, BR; Shaw, LJ; Masoudi, FA; Chang, PP; Stearns, SC; Mudrick, DW; Cowper, PA; Green, CL; Douglas, PS
Published in: Am Heart J
October 2013

BACKGROUND: Exercise stress testing is commonly obtained after percutaneous coronary intervention (PCI) performed for acute coronary syndromes (ACS). We compared the relationships between exercise echocardiography and nuclear testing after ACS-related PCI on outcomes and resource use. METHODS: Longitudinal observational study using fee-for-service Medicare claims to identify patients undergoing outpatient exercise stress testing with imaging within 15 months after PCI performed for ACS between 2003 and 2004. RESULTS: Of 63,100 patients undergoing stress testing 3 to 15 months post-PCI, 31,731 (50.3%) underwent an exercise stress test with imaging. Among 29,279 patients undergoing exercise stress testing with imaging, 15.5% received echocardiography. Echocardiography recipients had higher rates of repeat stress testing (adjusted hazard ratio [HR] 2.60, CI 2.19-3.10) compared with those undergoing nuclear imaging in the 90 days after testing, but lower rates of revascularization (adjusted HR 0.87, CI 0.76-0.98) and coronary angiography (adjusted HR 0.88, CI 0.80-0.97). None of these differences persisted subsequent to 90 days after stress testing. Rates of death and readmission for myocardial infarction rates were similar. Total Medicare payments were lower initially after echocardiography (incremental difference $498, CI 488-507), an effect attributed primarily to lower reimbursement for the stress test itself, but not significantly different after 14 months after testing. CONCLUSIONS: In this study using administrative data, echocardiography recipients initially had fewer invasive procedures but higher rates of repeat testing than nuclear testing recipients. However, these differences between echo and nuclear testing did not persist over longer time frames.

Duke Scholars

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

October 2013

Volume

166

Issue

4

Start / End Page

783 / 791.e4

Location

United States

Related Subject Headings

  • Retrospective Studies
  • Postoperative Care
  • Outpatients
  • Myocardial Revascularization
  • Male
  • Humans
  • Follow-Up Studies
  • Female
  • Exercise Test
  • Echocardiography
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Federspiel, J. J., Shah, B. R., Shaw, L. J., Masoudi, F. A., Chang, P. P., Stearns, S. C., … Douglas, P. S. (2013). Impact of choice of imaging modality accompanying outpatient exercise stress testing on outcomes and resource use after revascularization for acute coronary syndromes. Am Heart J, 166(4), 783-791.e4. https://doi.org/10.1016/j.ahj.2013.07.020
Federspiel, Jerome J., Bimal R. Shah, Leslee J. Shaw, Frederick A. Masoudi, Patricia P. Chang, Sally C. Stearns, Daniel W. Mudrick, Patricia A. Cowper, Cynthia L. Green, and Pamela S. Douglas. “Impact of choice of imaging modality accompanying outpatient exercise stress testing on outcomes and resource use after revascularization for acute coronary syndromes.Am Heart J 166, no. 4 (October 2013): 783-791.e4. https://doi.org/10.1016/j.ahj.2013.07.020.
Federspiel JJ, Shah BR, Shaw LJ, Masoudi FA, Chang PP, Stearns SC, et al. Impact of choice of imaging modality accompanying outpatient exercise stress testing on outcomes and resource use after revascularization for acute coronary syndromes. Am Heart J. 2013 Oct;166(4):783-791.e4.
Federspiel, Jerome J., et al. “Impact of choice of imaging modality accompanying outpatient exercise stress testing on outcomes and resource use after revascularization for acute coronary syndromes.Am Heart J, vol. 166, no. 4, Oct. 2013, pp. 783-791.e4. Pubmed, doi:10.1016/j.ahj.2013.07.020.
Federspiel JJ, Shah BR, Shaw LJ, Masoudi FA, Chang PP, Stearns SC, Mudrick DW, Cowper PA, Green CL, Douglas PS. Impact of choice of imaging modality accompanying outpatient exercise stress testing on outcomes and resource use after revascularization for acute coronary syndromes. Am Heart J. 2013 Oct;166(4):783-791.e4.
Journal cover image

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

October 2013

Volume

166

Issue

4

Start / End Page

783 / 791.e4

Location

United States

Related Subject Headings

  • Retrospective Studies
  • Postoperative Care
  • Outpatients
  • Myocardial Revascularization
  • Male
  • Humans
  • Follow-Up Studies
  • Female
  • Exercise Test
  • Echocardiography