To promote the rational use of cardiovascular imaging in patients with congenital heart disease, the American College of Cardiology developed Appropriate Use Criteria (AUC), but its clinical application and pre-release benchmarks have not been evaluated. We aimed to evaluate the appropriateness of indications for cardiovascular magnetic resonance (CMR) and cardiovascular computed tomography (CCT) in patients with conotruncal defects and to identify factors associated with maybe or rarely appropriate (M/R) indications.
Twelve centers each contributed a median of 147 studies performed prior to AUC publication (01/2020) on patients with conotruncal defects. To incorporate patient characteristics and center-level effects, a hierarchical generalized linear mixed model was used.
Of the 1753 studies (80% CMR, and 20% CCT), 16% were rated M/R. Center M/R ranged from 4 to 39%. Infants accounted for 8.4% of studies. In multivariable analyses, patient- and study-level factors associated with M/R rating included: age <1 year (OR 1.90 [1.15–3.13]), truncus arteriosus (vs. tetralogy of Fallot, OR 2.55 [1.5–4.35]), and CCT (vs. CMR, OR 2.67 [1.87–3.83]). None of the provider- or center-level factors reached statistical significance in the multivariable model.
Most CMRs and CCTs ordered for the follow-up care of patients with conotruncal defects were rated appropriate. However, there was significant center-level variation in appropriateness ratings. Younger age, CCT, and truncus arteriosus were independently associated with higher odds of M/R rating. These findings could inform future quality improvement initiatives and further exploration of factors resulting in center-level variation.
This multicenter study evaluates the appropriateness of cardiovascular magnetic resonance (CMR) and cardiovascular computed tomography (CCT) in patients with conotruncal defects prior to the release of the Appropriate Use Criteria (AUC). Of the 1753 studies (80% CMR, and 20% CCT), 16% were for maybe or rarely appropriate (M/R) indications. Center M/R ranged from 4 to 39%. The patient- and study-level factors associated with M/R rating included: age <1 year, truncus arteriosus, and CCT. Though most CMRs and CCTs were rated appropriate, there were significant center-level variations in appropriateness ratings that need further exploration.
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Published online: March 01, 2023
Accepted: January 24, 2023
Received in revised form: December 11, 2022
Received: November 7, 2022
Publication stageIn Press Journal Pre-Proof
© 2023 Published by Elsevier Inc. on behalf of Society of Cardiovascular Computed Tomography.