Comparative Trends and Downstream Outcomes of Coronary Computed Tomography Angiography and Cardiac Stress Testing in Emergency Department Patients With Chest Pain: An Administrative Claims Analysis

Jacob R. Morris, Fernanda Bellolio, Lindsey R. Sangaralingham, Stephanie R. Schilz, Nilay D Shah, Deepi G. Goyal, Malcolm R. Bell, Stephen L. Kopecky, Waqas I. Gilani, Erik P. Hess, Alan E. Jones

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Objectives: Coronary computerized tomography angiography (CCTA) is a rapidly emerging technology for the evaluation of chest pain in the emergency department (ED). We assessed trends in CCTA use and compared downstream healthcare utilization between CCTA and cardiac stress testing modalities. Methods: Using administrative claims data (Optum Labs Data Warehouse) from over 100 million geographically diverse privately insured and Medicare Advantage enrollees across the United States, we identified 2,047,799 ED patients from January 2006 to December 2013 who presented with chest pain and had a CCTA or cardiac stress test within 72 hours. Cohorts were established based on CCTA or functional stress testing (myocardial perfusion scintigraphy [MPS], stress echocardiogram [SE], or treadmill exercise electrocardiogram [TMET]) performed within 72 hours of the ED visit. We tracked subsequent invasive cardiac procedures (invasive coronary angiography [ICA], percutaneous coronary intervention [PCI], and coronary artery bypass grafting [CABG]), repeat noninvasive testing, return ED visits, hospitalization, and the rate of acute myocardial infarction (AMI) within 30 days. We used propensity-score matching to adjust for coronary artery disease (CAD) risk factors, Charlson-Deyo comorbidity index, and baseline differences between patients selected for CCTA or cardiac stress testing. Logistic regression was used to measure adjusted associations between testing modality and outcomes. Results: During the study period, CCTA use increased from 0.8% to 4.5% of all cardiac testing within 72 hours, a change of 434% (p-value for trend < 0.001), while rates of other cardiac stress testing modalities decreased (–22% for TMET [p < 0.001]; –11% for SE [p = 0.11]; –6% for MPS [p = 0.04]. After matching, there was no difference in the 30-day rate of AMI between testing modalities. Compared to MPS, CCTA was associated with higher rates of PCI (odds ratio [OR] = 1.25, 95% confidence interval [CI] = 1.04 to 1.51), and CABG (OR = 1.47; 95% CI = 1.03 to 2.13). Compared to SE and treadmill stress testing, CCTA was associated with more invasive procedures, hospitalizations, return ED visits, and repeat noninvasive testing. Conclusions: CCTA use increased fourfold during the study period and was associated with higher rates of PCI, CABG, repeat noninvasive testing, hospitalization, and return ED visits. The authors have no relevant financial information or potential conflicts to disclose.

Original languageEnglish (US)
Pages (from-to)1022-1030
Number of pages9
JournalAcademic Emergency Medicine
Volume23
Issue number9
DOIs
StatePublished - Sep 1 2016

Fingerprint

Insurance Claim Review
Chest Pain
Hospital Emergency Service
Angiography
Tomography
Myocardial Perfusion Imaging
Perfusion Imaging
Percutaneous Coronary Intervention
Coronary Artery Bypass
Hospitalization
Electrocardiography
Medicare Part C
Odds Ratio
Myocardial Infarction
Computed Tomography Angiography
Confidence Intervals
Exercise
Propensity Score
Coronary Angiography
Exercise Test

ASJC Scopus subject areas

  • Medicine(all)
  • Emergency Medicine

Cite this

Comparative Trends and Downstream Outcomes of Coronary Computed Tomography Angiography and Cardiac Stress Testing in Emergency Department Patients With Chest Pain : An Administrative Claims Analysis. / Morris, Jacob R.; Bellolio, Fernanda; Sangaralingham, Lindsey R.; Schilz, Stephanie R.; Shah, Nilay D; Goyal, Deepi G.; Bell, Malcolm R.; Kopecky, Stephen L.; Gilani, Waqas I.; Hess, Erik P.; Jones, Alan E.

In: Academic Emergency Medicine, Vol. 23, No. 9, 01.09.2016, p. 1022-1030.

Research output: Contribution to journalArticle

Morris, Jacob R. ; Bellolio, Fernanda ; Sangaralingham, Lindsey R. ; Schilz, Stephanie R. ; Shah, Nilay D ; Goyal, Deepi G. ; Bell, Malcolm R. ; Kopecky, Stephen L. ; Gilani, Waqas I. ; Hess, Erik P. ; Jones, Alan E. / Comparative Trends and Downstream Outcomes of Coronary Computed Tomography Angiography and Cardiac Stress Testing in Emergency Department Patients With Chest Pain : An Administrative Claims Analysis. In: Academic Emergency Medicine. 2016 ; Vol. 23, No. 9. pp. 1022-1030.
@article{3aa930a73ea747e18a0add9ecb4cfa2d,
title = "Comparative Trends and Downstream Outcomes of Coronary Computed Tomography Angiography and Cardiac Stress Testing in Emergency Department Patients With Chest Pain: An Administrative Claims Analysis",
abstract = "Objectives: Coronary computerized tomography angiography (CCTA) is a rapidly emerging technology for the evaluation of chest pain in the emergency department (ED). We assessed trends in CCTA use and compared downstream healthcare utilization between CCTA and cardiac stress testing modalities. Methods: Using administrative claims data (Optum Labs Data Warehouse) from over 100 million geographically diverse privately insured and Medicare Advantage enrollees across the United States, we identified 2,047,799 ED patients from January 2006 to December 2013 who presented with chest pain and had a CCTA or cardiac stress test within 72 hours. Cohorts were established based on CCTA or functional stress testing (myocardial perfusion scintigraphy [MPS], stress echocardiogram [SE], or treadmill exercise electrocardiogram [TMET]) performed within 72 hours of the ED visit. We tracked subsequent invasive cardiac procedures (invasive coronary angiography [ICA], percutaneous coronary intervention [PCI], and coronary artery bypass grafting [CABG]), repeat noninvasive testing, return ED visits, hospitalization, and the rate of acute myocardial infarction (AMI) within 30 days. We used propensity-score matching to adjust for coronary artery disease (CAD) risk factors, Charlson-Deyo comorbidity index, and baseline differences between patients selected for CCTA or cardiac stress testing. Logistic regression was used to measure adjusted associations between testing modality and outcomes. Results: During the study period, CCTA use increased from 0.8{\%} to 4.5{\%} of all cardiac testing within 72 hours, a change of 434{\%} (p-value for trend < 0.001), while rates of other cardiac stress testing modalities decreased (–22{\%} for TMET [p < 0.001]; –11{\%} for SE [p = 0.11]; –6{\%} for MPS [p = 0.04]. After matching, there was no difference in the 30-day rate of AMI between testing modalities. Compared to MPS, CCTA was associated with higher rates of PCI (odds ratio [OR] = 1.25, 95{\%} confidence interval [CI] = 1.04 to 1.51), and CABG (OR = 1.47; 95{\%} CI = 1.03 to 2.13). Compared to SE and treadmill stress testing, CCTA was associated with more invasive procedures, hospitalizations, return ED visits, and repeat noninvasive testing. Conclusions: CCTA use increased fourfold during the study period and was associated with higher rates of PCI, CABG, repeat noninvasive testing, hospitalization, and return ED visits. The authors have no relevant financial information or potential conflicts to disclose.",
author = "Morris, {Jacob R.} and Fernanda Bellolio and Sangaralingham, {Lindsey R.} and Schilz, {Stephanie R.} and Shah, {Nilay D} and Goyal, {Deepi G.} and Bell, {Malcolm R.} and Kopecky, {Stephen L.} and Gilani, {Waqas I.} and Hess, {Erik P.} and Jones, {Alan E.}",
year = "2016",
month = "9",
day = "1",
doi = "10.1111/acem.13005",
language = "English (US)",
volume = "23",
pages = "1022--1030",
journal = "Academic Emergency Medicine",
issn = "1069-6563",
publisher = "Wiley-Blackwell",
number = "9",

}

TY - JOUR

T1 - Comparative Trends and Downstream Outcomes of Coronary Computed Tomography Angiography and Cardiac Stress Testing in Emergency Department Patients With Chest Pain

T2 - An Administrative Claims Analysis

AU - Morris, Jacob R.

AU - Bellolio, Fernanda

AU - Sangaralingham, Lindsey R.

AU - Schilz, Stephanie R.

AU - Shah, Nilay D

AU - Goyal, Deepi G.

AU - Bell, Malcolm R.

AU - Kopecky, Stephen L.

AU - Gilani, Waqas I.

AU - Hess, Erik P.

AU - Jones, Alan E.

PY - 2016/9/1

Y1 - 2016/9/1

N2 - Objectives: Coronary computerized tomography angiography (CCTA) is a rapidly emerging technology for the evaluation of chest pain in the emergency department (ED). We assessed trends in CCTA use and compared downstream healthcare utilization between CCTA and cardiac stress testing modalities. Methods: Using administrative claims data (Optum Labs Data Warehouse) from over 100 million geographically diverse privately insured and Medicare Advantage enrollees across the United States, we identified 2,047,799 ED patients from January 2006 to December 2013 who presented with chest pain and had a CCTA or cardiac stress test within 72 hours. Cohorts were established based on CCTA or functional stress testing (myocardial perfusion scintigraphy [MPS], stress echocardiogram [SE], or treadmill exercise electrocardiogram [TMET]) performed within 72 hours of the ED visit. We tracked subsequent invasive cardiac procedures (invasive coronary angiography [ICA], percutaneous coronary intervention [PCI], and coronary artery bypass grafting [CABG]), repeat noninvasive testing, return ED visits, hospitalization, and the rate of acute myocardial infarction (AMI) within 30 days. We used propensity-score matching to adjust for coronary artery disease (CAD) risk factors, Charlson-Deyo comorbidity index, and baseline differences between patients selected for CCTA or cardiac stress testing. Logistic regression was used to measure adjusted associations between testing modality and outcomes. Results: During the study period, CCTA use increased from 0.8% to 4.5% of all cardiac testing within 72 hours, a change of 434% (p-value for trend < 0.001), while rates of other cardiac stress testing modalities decreased (–22% for TMET [p < 0.001]; –11% for SE [p = 0.11]; –6% for MPS [p = 0.04]. After matching, there was no difference in the 30-day rate of AMI between testing modalities. Compared to MPS, CCTA was associated with higher rates of PCI (odds ratio [OR] = 1.25, 95% confidence interval [CI] = 1.04 to 1.51), and CABG (OR = 1.47; 95% CI = 1.03 to 2.13). Compared to SE and treadmill stress testing, CCTA was associated with more invasive procedures, hospitalizations, return ED visits, and repeat noninvasive testing. Conclusions: CCTA use increased fourfold during the study period and was associated with higher rates of PCI, CABG, repeat noninvasive testing, hospitalization, and return ED visits. The authors have no relevant financial information or potential conflicts to disclose.

AB - Objectives: Coronary computerized tomography angiography (CCTA) is a rapidly emerging technology for the evaluation of chest pain in the emergency department (ED). We assessed trends in CCTA use and compared downstream healthcare utilization between CCTA and cardiac stress testing modalities. Methods: Using administrative claims data (Optum Labs Data Warehouse) from over 100 million geographically diverse privately insured and Medicare Advantage enrollees across the United States, we identified 2,047,799 ED patients from January 2006 to December 2013 who presented with chest pain and had a CCTA or cardiac stress test within 72 hours. Cohorts were established based on CCTA or functional stress testing (myocardial perfusion scintigraphy [MPS], stress echocardiogram [SE], or treadmill exercise electrocardiogram [TMET]) performed within 72 hours of the ED visit. We tracked subsequent invasive cardiac procedures (invasive coronary angiography [ICA], percutaneous coronary intervention [PCI], and coronary artery bypass grafting [CABG]), repeat noninvasive testing, return ED visits, hospitalization, and the rate of acute myocardial infarction (AMI) within 30 days. We used propensity-score matching to adjust for coronary artery disease (CAD) risk factors, Charlson-Deyo comorbidity index, and baseline differences between patients selected for CCTA or cardiac stress testing. Logistic regression was used to measure adjusted associations between testing modality and outcomes. Results: During the study period, CCTA use increased from 0.8% to 4.5% of all cardiac testing within 72 hours, a change of 434% (p-value for trend < 0.001), while rates of other cardiac stress testing modalities decreased (–22% for TMET [p < 0.001]; –11% for SE [p = 0.11]; –6% for MPS [p = 0.04]. After matching, there was no difference in the 30-day rate of AMI between testing modalities. Compared to MPS, CCTA was associated with higher rates of PCI (odds ratio [OR] = 1.25, 95% confidence interval [CI] = 1.04 to 1.51), and CABG (OR = 1.47; 95% CI = 1.03 to 2.13). Compared to SE and treadmill stress testing, CCTA was associated with more invasive procedures, hospitalizations, return ED visits, and repeat noninvasive testing. Conclusions: CCTA use increased fourfold during the study period and was associated with higher rates of PCI, CABG, repeat noninvasive testing, hospitalization, and return ED visits. The authors have no relevant financial information or potential conflicts to disclose.

UR - http://www.scopus.com/inward/record.url?scp=84986587025&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84986587025&partnerID=8YFLogxK

U2 - 10.1111/acem.13005

DO - 10.1111/acem.13005

M3 - Article

C2 - 27155236

AN - SCOPUS:84986587025

VL - 23

SP - 1022

EP - 1030

JO - Academic Emergency Medicine

JF - Academic Emergency Medicine

SN - 1069-6563

IS - 9

ER -