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Heart Test Often Overused, Michigan-Based Study Learns

A test for heart problems called coronary CT angiography is overused as much as 15% of the time, a costly intervention that can lead to complications, a Michigan study published today says.

A Michigan initiative among 47 hospitals reduced inappropriate tests to 5% by simple measures, such as educating doctors about overuse of the tests, according to Dr. Kavitha Chinnaiyan, who led the study; it was published in the online edition of the Journal of the American College of Cardiology.

Coronary CT angiography uses a dye and special X-rays injected into a person's arm to find blockages inside coronary arteries. Complications are rare but include kidney failure and other problems from the dye, particularly in higher risk patients.

The test varies in cost from $500 to as much as $1,500. It is the fastest growing segment of CT services in the U.S., said Chinnaiyan director of advanced cardiac imaging education at the Beaumont Health System, Royal Oak.

Use of the procedure has grown since 2000 because CT technology is widely available and has a high rate of accuracy finding problems. Doctors also may overuse the test to avoid future malpractice lawsuits alleging they did not do enough to find a problem, she said.

Chinnaiyan said the test is best for people with a low-to-moderate risk of heart problems who go to a hospital emergency department with chest pain or who have had other heart tests that are inconclusive.

Inappropriate use of the test dropped from 15% to less than 5% among the Michigan hospitals in the study, she said.

It was conducted by reviewing data of more than 25,000 Michigan patients from July 2007 to December 2010.

It was funded by Blue Cross Blue Shield of Michigan as part of a statewide hospital quality and safety improvement initiatives.

Source: Patricia Anstett-Detroit Free Press at: panstett@freepress.com

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