AHA 2016: Rate of cardiac stress testing increases among commercially insured

The use of cardiac stress testing increased by 3 percent from 2005 to 2012 among a commercially insured group of men and women, according to a cross-sectional study.

During that period, the use of nuclear single-photon emission computed tomography decreased by 14.9 percent, the use of stress echocardiography increased by 27.8 percent, the use of exercise electrocardiography increased by 12.5 percent and the use of other stress testing modalities increased by 65.5 percent.

Lead researcher Vinay Kini, MD, of the Hospital of the University of Pennsylvania, and colleagues published their results online in JAMA Cardiology on Nov. 15.

The findings were also presented in an oral abstract session at the American Heart Association Scientific Sessions in New Orleans.

Previous studies in recent years showed the rates of cardiac stress testing declined among Medicare beneficiaries and a commercially insured group since 2006, according to the researchers.

“These findings suggest that trends in the use of cardiac stress testing may be driven more strongly by unique characteristics of health systems and populations than national efforts by physician groups to reduce overuse of testing,” the researchers wrote.

For this analysis, they obtained data from the Clinformatics Data Mart, a database of administrative health claims for members of a large, national managed care company. They identified administrative claims from members from 2005 to 2012.

The study included 32,921,838 members who were between 25 and 64 years old. The mean age was 43.2 years old, and 49.5 percent of the members were women and 76.9 percent were white.

During the study, physicians performed 2,085,591 cardiac stress tests. The rates of cardiac stress testing were 3,486 tests per 100,000 person-years in 2005; 3,933 tests per 100,000 person-years in 2009; and 3,598 tests per 100,000 person-years in 2012.

Among the members who were 25 to 34 years old, the rate of cardiac stress testing increased 59.1 percent from 2005 to 2012. During that same time period, the rates of cardiac stress testing increased 30.7 percent among members from 35 to 44 years old, did not significantly change among members from 45 to 54 years old and decreased by 12.3 percent among members from 55 to 64 years old.

In 2005, the rates of cardiac stress testing were 543 tests per 100,000 person-years in members from 25 to 34 years old; 1,908 tests per 100,000 person-years in members from 35 to 44 years old; 4,482 tests per 100,000 person-years in members from 45 to 54 years old; and 7,894 tests per 100,000 person-years in members from 55 to 64 years old.

In 2012, the rates were 864 tests per 100,000 person-years; 2,493 tests per 100,000 person-years; 4,544 tests per 100,000 person-years; and 6,923 tests per 100,000 person-years.

The researchers cited a few limitations of the study, including that they did not have details on the indications for cardiac stress tests. They also could not determine if there was differential enrollment of sicker persons or disenrollment of healthier persons.

“Divergent trends in the use of cardiac stress testing between populations suggest that organizational characteristics of health systems, including payment models, may influence the use of cardiovascular testing,” the researchers wrote. “Trends in the use of cardiac imaging derived from single health systems or insurers may not reflect larger practice patterns.”