Using cardiac CT before electrophysiologic procedures for anatomical mapping, or prior to repeat sternotomy in reoperative cardiac surgery, also was rated appropriate.
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).
Creation of the report was funded by the American College of Cardiology Foundation and by the other professional societies. Dr. Taylor reported that he has been a consultant to Abbott Laboratories and has received research funds from 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.
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Report Will Change Practice, Payment
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. The criteria expand to stents and bypass grafts, and this will open doors for patients and clinicians.
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 are also incorporating cardiac CT into their practices, expediting cardiac work-ups with a more accurate and less expensive test.
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.
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