According to a study recently published in the journal JAMA, there has been a steppe decrease since 2006 in the use of nuclear myocardial perfusion imaging (MPI; an imaging procedure used to determine areas of the heart with decreased blood flow), a decline that cannot be offered an explanation by an increase in other imaging methods.
Nuclear myocardial perfusion imaging was in fact responsible for much of the speedy growth in cardiac imaging that took place from the 1990s through the middle 2000s.
Edward J. McNulty, M.D., of Kaiser Permanente Medical Center, San Francisco, and colleagues performed a study to examine trends in MPI use within a large, community-based population. They attained patient data for MPI conducted from 2000-2011 for members aged 30 years or older from the clinical databases of Kaiser Permanente Northern California, an incorporated health care delivery service system that provides inpatient and outpatient care for more than 2.3 million adults.
All in all, MPI was used for 302,506 patients at 19 facilities. From 2000 until 2006, MPI use saw an increase by a relative 41 percent. In addition, between 2006 and 2011, MPI use declined a relative 51 percent. Declines from 2006 to 2011 were much more present for outpatients than inpatients (58 percent as opposed to 31 percent) and for individuals younger than 65 years. Use of cardiac computed tomography (at the time a newer imaging procedure) saw a significant increase in use during this time period, and could have accounted for 5 percent of the observed decline in overall MPI use if performed as an alternative.
"Although the abrupt nature of the decline suggests changing physician behavior played a major role, incident coronary disease, as assessed by heart attack, also declined by 27 percent. We could not determine the relative effects of these factors on MPI use. The substantial reduction in MPI use demonstrates the ability to reduce testing on a large scale with anticipated reductions in health care costs," the authors wrote.
