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Temporal trends in the utilization of non-invasive diagnostic tests for coronary artery disease in Ontario between 2008-2014: a population based study


The proliferation of cardiac diagnostic tests over the past few decades has received substantial attention from policymakers. However, contemporary population-based temporal trends of the utilization of cardiac non-invasive diagnostic tests for coronary artery disease are not available. Our objective was to examine the temporal trends in utilization of coronary computed tomography angiography (CCTA), myocardial perfusion imaging (MPI), exercise stress testing (GXT) and stress echocardiography between 2008-2014. We performed a population-based repeated cross-sectional study of the adult population of Ontario between January 1, 2008 and Dec 31, 2014. Annual rates of non-invasive cardiac diagnostic tests were computed. For each cardiac testing modality, a negative binomial regression model was used to assess temporal changes in test use.

GXT and MPI collectively accounted for 88% of all cardiac non- invasive diagnostic tests throughout our study period. Age-and-sex-standardized rates of GXT declined from 26.7 to 21.6/1000 (mean annual reduction of 3.4%, p<0.001). MPI rates declined from 21.1 to 19.5/1000 (mean annual reduction of 1.3%, p<0.001). While utilization rates for both CCTA and stress echocardiography increased over time, the combined rate of all available tests decreased from 50.8 to 49.1/1000 (mean annual reduction of 1.1%, p<0.001). In conclusion, utilization rates for the most prevalent non-invasive cardiac diagnostic tests, GXT and MPI, declined over our study period. Furthermore, the overall test utilization rate also declined over time. We believe our findings are encouraging from a health policy perspective. Nonetheless, rising utilization rates for CCTA and stress echo will need to be monitored in the future.



Roifman I, Wijeysundera HC, Austin PC, Maclagan LC, Rezai MR, Wright GA, Tu JV. Can J Cardiol. 2017; 33(2):279-82. Epub 2016 Aug 1.

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