Cardiovascular Imaging Research at the Crossroads

Leslee J. Shaw; James K. Min; Rory Hachamovitch; Eric D. Peterson; Robert C. Hendel; Pamela K. Woodard; Daniel S. Berman; Pamela S. Douglas

doi:10.1016/j.jcmg.2009.11.010

Cardiovascular Imaging Research at the Crossroads

Leslee J. Shaw, James K. Min, Rory Hachamovitch, Eric D. Peterson, Robert C. Hendel, Pamela K. Woodard, Daniel S. Berman, Pamela S. Douglas

Research output: Contribution to journal › Article › peer-review

73 Scopus citations

Abstract

Cardiovascular (CV) imaging plays a critical role in therapeutic decision making and is performed in more than 10 million patients each year; a large share of the nearly 40 million patients living with CV disease. CV imaging may serve as a valuable component of a patient's evaluation, provided that its enhanced diagnostic findings invoke appropriate and targeted therapies that improve symptom burden and long-term outcomes and are not offset by the upfront procedural and induced costs of care. As well, the overall clinical benefit that imaging imparts to the patient must significantly outweigh any untoward risk, including radiation or procedural complications. Explosive growth in imaging has resulted in a rapid escalation of costs for testing encumbering an estimated $80 billion dollars annually and represents a sizeable portion of cardiologists' income. Concern remains that continued expansion of CV imaging services may further add to the complexity of health care services and magnify the societal burden of health care. The field of CV imaging is beset by high procedural use, high growth rates, and often, a lack of demonstrable quality. The end result of our current health care system and reimbursement models is an over emphasis on volume and throughput, extensive efforts necessary for justification of procedural use, and a broad referral population exceeding guideline-accepted best practices. An inextricable link between imaging markers and outcomes forms a critical nexus that can be used to establish the value of a test, and is now the standard upon which technology will be evaluated by private payers and governmental agencies alike. This new benchmark necessitates high-quality research to compare the effectiveness of CV imaging modalities to elicit improvements in health outcomes; representing a dramatic paradigm shift for the field of CV imaging research. In this review, we will discuss current health policy of CV imaging as well as the future of CV imaging-based comparative effectiveness research.

Original language	English (US)
Pages (from-to)	316-324
Number of pages	9
Journal	JACC: Cardiovascular Imaging
Volume	3
Issue number	3
DOIs	https://doi.org/10.1016/j.jcmg.2009.11.010
State	Published - Mar 2010
Externally published	Yes

Keywords

health policy
imaging
research

ASJC Scopus subject areas

Radiology Nuclear Medicine and imaging
Cardiology and Cardiovascular Medicine

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10.1016/j.jcmg.2009.11.010

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title = "Cardiovascular Imaging Research at the Crossroads",

abstract = "Cardiovascular (CV) imaging plays a critical role in therapeutic decision making and is performed in more than 10 million patients each year; a large share of the nearly 40 million patients living with CV disease. CV imaging may serve as a valuable component of a patient's evaluation, provided that its enhanced diagnostic findings invoke appropriate and targeted therapies that improve symptom burden and long-term outcomes and are not offset by the upfront procedural and induced costs of care. As well, the overall clinical benefit that imaging imparts to the patient must significantly outweigh any untoward risk, including radiation or procedural complications. Explosive growth in imaging has resulted in a rapid escalation of costs for testing encumbering an estimated $80 billion dollars annually and represents a sizeable portion of cardiologists' income. Concern remains that continued expansion of CV imaging services may further add to the complexity of health care services and magnify the societal burden of health care. The field of CV imaging is beset by high procedural use, high growth rates, and often, a lack of demonstrable quality. The end result of our current health care system and reimbursement models is an over emphasis on volume and throughput, extensive efforts necessary for justification of procedural use, and a broad referral population exceeding guideline-accepted best practices. An inextricable link between imaging markers and outcomes forms a critical nexus that can be used to establish the value of a test, and is now the standard upon which technology will be evaluated by private payers and governmental agencies alike. This new benchmark necessitates high-quality research to compare the effectiveness of CV imaging modalities to elicit improvements in health outcomes; representing a dramatic paradigm shift for the field of CV imaging research. In this review, we will discuss current health policy of CV imaging as well as the future of CV imaging-based comparative effectiveness research.",

keywords = "health policy, imaging, research",

author = "Shaw, {Leslee J.} and Min, {James K.} and Rory Hachamovitch and Peterson, {Eric D.} and Hendel, {Robert C.} and Woodard, {Pamela K.} and Berman, {Daniel S.} and Douglas, {Pamela S.}",

note = "Funding Information: Another option for the development of CER trials and registries is funding through pharmaceutical/equipment manufacturers or payers. Companies providing equipment or drugs for CV imaging and third-party payers have yet to make this level of investment in clinical research. Although unusual, a powerful example of success using this funding route is the Advanced Cardiac Imaging Consortium registry supported by Michigan Blue Cross ( 50 ). One can only hope that revisions to current funding will ensue on the part of such companies; given recent National Coverage Determination (NCD) from CMS indicating that broader evidence on improvements in clinical outcomes with imaging is required to form the basis for coverage decisions ( 32,33 ). Funding Information: The gap in knowledge on the relationship between CV imaging and outcomes has recently been recognized by the National Institutes of Health–National Heart, Lung, and Blood Institute (NIH-NHLBI) in its most recent strategic plan ( 51 ). The NHLBI plan called for research to optimize diagnostic testing and identify strategies that improve outcomes. Historically, the majority of NIH funding for imaging has been provided for oncologic imaging through the National Cancer Institute. However, the NHLBI plan states that studies are needed to “reduce the inappropriate use of diagnostic tests and treatments” (Challenge 3.1.c), to “evaluate the risks, benefits, and costs of diagnostic tests and treatments in representative populations and settings” (Challenge 3.2.a), and to “establish evidence-based guidelines for prevention, diagnosis, and treatment and identify gaps in knowledge” (Challenge 3.3a) ( 51 ). ",

year = "2010",

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doi = "10.1016/j.jcmg.2009.11.010",

language = "English (US)",

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AU - Shaw, Leslee J.

AU - Min, James K.

AU - Hachamovitch, Rory

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AU - Hendel, Robert C.

AU - Woodard, Pamela K.

AU - Berman, Daniel S.

AU - Douglas, Pamela S.

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N2 - Cardiovascular (CV) imaging plays a critical role in therapeutic decision making and is performed in more than 10 million patients each year; a large share of the nearly 40 million patients living with CV disease. CV imaging may serve as a valuable component of a patient's evaluation, provided that its enhanced diagnostic findings invoke appropriate and targeted therapies that improve symptom burden and long-term outcomes and are not offset by the upfront procedural and induced costs of care. As well, the overall clinical benefit that imaging imparts to the patient must significantly outweigh any untoward risk, including radiation or procedural complications. Explosive growth in imaging has resulted in a rapid escalation of costs for testing encumbering an estimated $80 billion dollars annually and represents a sizeable portion of cardiologists' income. Concern remains that continued expansion of CV imaging services may further add to the complexity of health care services and magnify the societal burden of health care. The field of CV imaging is beset by high procedural use, high growth rates, and often, a lack of demonstrable quality. The end result of our current health care system and reimbursement models is an over emphasis on volume and throughput, extensive efforts necessary for justification of procedural use, and a broad referral population exceeding guideline-accepted best practices. An inextricable link between imaging markers and outcomes forms a critical nexus that can be used to establish the value of a test, and is now the standard upon which technology will be evaluated by private payers and governmental agencies alike. This new benchmark necessitates high-quality research to compare the effectiveness of CV imaging modalities to elicit improvements in health outcomes; representing a dramatic paradigm shift for the field of CV imaging research. In this review, we will discuss current health policy of CV imaging as well as the future of CV imaging-based comparative effectiveness research.

AB - Cardiovascular (CV) imaging plays a critical role in therapeutic decision making and is performed in more than 10 million patients each year; a large share of the nearly 40 million patients living with CV disease. CV imaging may serve as a valuable component of a patient's evaluation, provided that its enhanced diagnostic findings invoke appropriate and targeted therapies that improve symptom burden and long-term outcomes and are not offset by the upfront procedural and induced costs of care. As well, the overall clinical benefit that imaging imparts to the patient must significantly outweigh any untoward risk, including radiation or procedural complications. Explosive growth in imaging has resulted in a rapid escalation of costs for testing encumbering an estimated $80 billion dollars annually and represents a sizeable portion of cardiologists' income. Concern remains that continued expansion of CV imaging services may further add to the complexity of health care services and magnify the societal burden of health care. The field of CV imaging is beset by high procedural use, high growth rates, and often, a lack of demonstrable quality. The end result of our current health care system and reimbursement models is an over emphasis on volume and throughput, extensive efforts necessary for justification of procedural use, and a broad referral population exceeding guideline-accepted best practices. An inextricable link between imaging markers and outcomes forms a critical nexus that can be used to establish the value of a test, and is now the standard upon which technology will be evaluated by private payers and governmental agencies alike. This new benchmark necessitates high-quality research to compare the effectiveness of CV imaging modalities to elicit improvements in health outcomes; representing a dramatic paradigm shift for the field of CV imaging research. In this review, we will discuss current health policy of CV imaging as well as the future of CV imaging-based comparative effectiveness research.

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Cardiovascular Imaging Research at the Crossroads

Abstract

Keywords

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