Cardiac Testing

Cardiac Testing Educational Booklet Series

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Noninvasive Cardiac Testing for the Assessment of Coronary Artery Disease

Learn more about the noninvasive cardiac testing modalities available for risk assessment and evaluation of coronary artery disease (CAD).

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Patient Care Pathways for the Evaluation of Coronary Artery Disease

From initial risk assessment to coordination of care, find out more about guideline-based pathways for evaluating CAD.

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The Clinical Value of SPECT in Evaluating Coronary Artery Disease

Get more information about the most widely used nuclear imaging modality—single-photon emission computed tomography myocardial perfusion imaging (SPECT MPI).

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Additional Downloadable Materials

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Cardiac Testing Preparation Tips

Refer to this checklist to help your patients prepare for a cardiac imaging test.

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The Hierarchy of Indications for Ordering Tests

Utilize this flowchart for patients who may have multiple clinical indications. This hierarchy of indications can help you assess test appropriateness and is based on the ACCF/AHA Multimodality AUC.

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Interactive Resources for the Multimodality AUC

Learn more about the tools and resources we have to help you stay up to date with the Multimodality AUC.

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Online Resources

AUCTracker.com and the AUC App

Download the Multimodality AUC app, available for most platforms. Cardiac imaging test appropriateness ratings are based on the ACCF/AHA Multimodality AUC.

Register for a free AUC Tracker account to securely save and track your AUC data for radionuclide imaging. The AUC Tracker works seamlessly with the AUC app.

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AstellasPatientResources.com

Download customizable resources for your practice to help prepare your patients for a nuclear stress test experience. Access tools such as the presentation on Understanding SPECT MPI and Prepping Your Patients.

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References

Home

Centers for Medicare & Medicaid Services. Medicare program: revisions to payment policies under the physician fee schedule and other revisions to Part B for CY 2017; final rule. Fed Regist 2016;81:80403‐28.

Patient Workup

Mozaffarian D, Benjamin EJ, Go AS, et al. Heart disease and stroke statistics—2016 update: a report from the American Heart Association. Circulation 2016;133(4):e38-360.
Xu J, Murphy SL, Kochanek KD, Bastian BA. Deaths: final data for 2013. Natl Vital Stat Rep 2016;64(2):1-119.
National Heart, Lung, and Blood Institute. What Is Coronary Heart Disease? (06-22-2016). http://www.nhlbi.nih.gov/health/health-topics/topics/cad. Accessed 05-25-2017.
Fihn SD, Gardin JM, Abrams J, et al. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the diagnosis and management of patients with stable ischemic heart disease. J Am Coll Cardiol 2012;60(24):e44-164.
Anderson JL, Adams CD, Antman EM, et al. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non ST-elevation myocardial infarction. Circulation 2007;116(7):e148-304.
National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation 2002;106(25):3143-421.
National Heart, Lung, and Blood Institute.Ð What Are Coronary Heart Disease Risk Factors? (06-22-2016). https://www.nhlbi.nih.gov/health/health-topics/topics/hd. Accessed 05-25-2017.
Goff DC, Lloyd-Jones DM, Benett G, et al. 2013 ACC/AHA guideline on the assessment of cardiovascular risk. Circulation 2014;129(25 Suppl 2):S49-73.
Pencina MJ, D'Agostino RB Sr, Larson MG, Massaro JM, Vasan RS. Predicting the 30-year risk of cardiovascular disease: the Framingham Heart Study. Circulation 2009;119(24):3078-84.
Ridker PM, Buring JE, Rifai N, Cook NR. Development and validation of improved algorithms for the assessment of global cardiovascular risk in women: the Reynolds Risk Score. JAMA 2007;297(6):611-9. Erratum in: JAMA 2007;297(13):1433.
Ridker PM, Paynter, NP, Rifai N, Cook NR. C-reactive protein and parental history improve global cardiovascular risk prediction. Circulation 2008;118(22):2243-51.

Appropriate Use Criteria

Centers for Medicare & Medicaid Services. Medicare program: revisions to payment policies under the physician fee schedule and other revisions to Part B for CY 2017; final rule. Fed Regist 2016;81:80403‐28.
Centers for Medicare & Medicaid Services. Medicare program; revisions to payment policies under the physician fee schedule and other revisions to Part B for CY 2018; Medicare Shared Savings Program requirements; and Medicare Diabetes Prevention Program; final rule. Fed Regist 2017;82(219):52976-3371.
Centers for Medicare & Medicaid Services. Medicare program: revisions to payment policies under the physician fee schedule and other revisions to Part B for CY 2016; final rule. Fed Regist 2015;80:70886‐1386.
Centers for Medicare & Medicaid Services. Provider Led Entities (09-09-2016). https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Appropriate-Use-Criteria-Program/PLE.html. Accessed 05-25-2017.
Wolk MJ, Bailey SR, Doherty JU, et al. ACCF/AHA/ASE/ASNC/HFSA/HRS/SCAI/SCCT/SCMR/STS 2013 multimodality appropriate use criteria for the detection and risk assessment of stable ischemic heart disease. J Am Coll Cardiol 2014;63(4):380-406.
Centers for Medicare & Medicaid Services. Clinical Decision Support Mechanisms (11-20-2017). https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Appropriate-Use-Criteria-Program/CDSM.html. Accessed 01-30-2018.
MedPAC. Report to the Congress: Medicare Payment Policy (03-01-2005). http://www.medpac.gov/docs/default-source/reports/Mar05_EntireReport.pdf. Accessed 05-10-2017.
Wennberg JE, Birkmeyer JD, eds. The Dartmouth Atlas of Cardiovascular Health Care. 1st ed. Chicago, IL: AHA Press, 1999.
Lee DW, Rawson JV, Wade SW. Radiology benefit managers: cost saving or cost shifting? J Am Coll Radiol 2011;8(6):393-401.
Patel MR, Wolk MJ, Allen JM, Dehmer GJ, Brindis RG. The privilege of self-regulation: the role of appropriate use criteria. J Am Coll Cardiol 2011;57(14):1557-59.
Hendel RC, Cerqueira M, Douglas PS, et al. A multicenter assessment of the use of single-photon emission computed tomography myocardial perfusion imaging with appropriateness criteria. J Am Coll Cardiol 2010;55(2):156-62.
Protecting Access to Medicare Act of 2014. HR 4302, 113th Leg, 2nd Sess (2014). https://www.gpo.gov/fdsys/pkg/BILLS-113hr4302enr/pdf/BILLS-113hr4302enr.pdf. Accessed 05-25‐2017.

Noninvasive Cardiac Tests

Fihn SD, Gardin JM, Abrams J, et al. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease. J Am Coll Cardiol 2012;60(24):e44-164.
Wolk MJ, Bailey SR, Doherty JU, et al. ACCF/AHA/ASE/ASNC/HFSA/HRS/SCAI/SCCT/SCMR/STS 2013 multimodality appropriate use criteria for the detection and risk assessment of stable ischemic heart disease. J Am Coll Cardiol 2014;63(4):380-406.
Balady GJ, Morise AP. Exercise testing. In: Mann DL, Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders, 2015:155-78.
Fletcher GF, Ades PA, Kligfield P, et al. Exercise standards for testing and training: a scientific statement from the American Heart Association. Circulation 2013;128(8):873-934.
Shaw LJ, Peterson ED, Shaw LK, et al. Use of a prognostic treadmill score in identifying diagnostic coronary disease subgroups. Circulation 1998;98(16):1622-30.
Gibbons RJ, Balady GJ, Bricker JT, et al. ACC/AHA 2002 guideline update for exercise testing. J Am Coll Cardiol 2002;40(8):1531-40.
Udelson JE, Dilsizian V, Bonow RO. Nuclear cardiology. In: Mann DL, Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders, 2015:271-319.
American Heart Association. Single Photon Emission Computed Tomography (SPECT) (09-19-2016). http://www.heart.org/HEARTORG/Conditions/HeartAttack/DiagnosingaHeartAttack/Single-Photon-Emission-Computed-Tomography-SPECT_UCM_446358_Article.jsp. Accessed 05-25-2017.
Henzlova MJ, Duvall WL, Einstein AJ, Travin MI, Verberne HJ. ASNC imaging guidelines for SPECT nuclear cardiology procedures: stress, protocols, and tracers. J Nucl Cardiol 2016;23(3):606-39, Erratum in: J Nucl Cardiol 2016;23(3):640-2.
Centers for Medicare & Medicaid Services. Medicare program: revisions to payment policies under the physician fee schedule and other revisions to Part B for CY 2016; final rule. Fed Regist 2015;80:70886‐1386.
National Heart, Lung, and Blood Institute. Stress Testing (12-14-2011). https://www.nhlbi.nih.gov/book/export/html/4858. Accessed 05-25-2017.
National Heart, Lung, and Blood Institute. Who Needs Echocardiography? (10-31-2011). https://www.nhlbi.nih.gov/health/health-topics/topics/echo/whoneeds. Accessed 05-25-2017.
Solomon SD, Wu J, Gillam L. Echocardiography. In: Mann DL, Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders, 2015:179-260.
Kwong RY. Cardiovascular magnetic resonance imaging. In: Mann DL, Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders, 2015:320-40.
National Heart, Lung, and Blood Institute. Cardiac MRI (12-09-2016). https://www.nhlbi.nih.gov/health/health-topics/topics/mri. Accessed 05-25-2017.
Taylor AJ. Cardiac computed tomography. In: Mann DL, Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders, 2015:341-63.

Patient Education

National Heart, Lung, and Blood Institute. What Is Coronary Heart Disease? (06-22-2016). http://www.nhlbi.nih.gov/health/health-topics/topics/cad. Accessed 05-25-2017.
Fihn SD, Gardin JM, Abrams J, et al. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease. J Am Coll Cardiol 2012;60(24):e44-164.
National Heart, Lung, and Blood Institute. What Are Coronary Heart Disease Risk Factors? (06-22-2016). https://www.nhlbi.nih.gov/health/health-topics/topics/hd. Accessed 05-25-2017.
National Heart, Lung, and Blood Institute. Coronary Heart Disease Risk Factors. (06-22-2016). https://www.nhlbi.nih.gov/health/health-topics/topics/hd/atrisk. Accessed 04-19-2017.
National Heart, Lung, and Blood Institute. How to Prevent and Control Coronary Heart Disease Risk Factors. (06-22-2016). https://www.nhlbi.nih.gov/health/health-topics/topics/hd/prevent. Accessed 04-19-2017.
Mozaffarian D, Benjamin EJ, Go AS, et al. Heart disease and stroke statistics—2016 update: a report from the American Heart Association. Circulation 2016;133(4):e38-360.
United States Census Bureau. Projections of the Size and Composition of the U.S. Population: 2014 to 2060 (03-2015). https://www.census.gov/content/dam/Census/library/publications/2015/demo/p25-1143.pdf. Accessed 05-30-2017.
Xu J, Murphy SL, Kochanek KD, Bastian BA. Deaths: final data for 2013. Natl Vital Stat Rep 2016;64(2):1-119.
Wolk MJ, Bailey SR, Doherty JU, et al. ACCF/AHA/ASE/ASNC/HFSA/HRS/SCAI/SCCT/SCMR/STS 2013 multimodality appropriate use criteria for the detection and risk assessment of stable ischemic heart disease. J Am Coll Cardiol 2014;63(4):380-406.
Henzlova MJ, Duvall WL, Einstein AJ, Travin MI, Verberne HJ. ASNC imaging guidelines for SPECT nuclear cardiology procedures: stress, protocols, and tracers. J Nucl Cardiol 2016;23(3):606-39.

Library

Practice Resources

Cardiac Testing Educational Booklet Series

Noninvasive Cardiac Testing for the Assessment of Coronary Artery Disease

Patient Care Pathways for the Evaluation of Coronary Artery Disease