Appropriate utilization of cardiac magnetic resonance for the assessment of heart failure and potential associated cost savings

BackgroundThe rapid growth in cardiac imaging utilization has led to the development of appropriate use criteria (AUC) in an effort to control costs. Recently, cardiac MRI has developed into a valuable modality in the evaluation of cardiac disease. However, there are no studies examining the appropriate use of cardiac MRI in clinical practice. PurposeTo determine the appropriate utilization of cardiac MRI in a large quaternary care institution and to compare percentages of appropriate utilization pre- and postpublication of the AUC document. We hypothesized that percentages of appropriate cardiac MRI utilization will be similar to those of other comparable cardiac imaging modalities and that there would be a significant change in appropriate use pre- and post-AUC publication. Study TypeRetrospective cohort study. PopulationIn all, 2032 consecutive patients undergoing cardiac MRI for the assessment of heart failure between 2012-2016. Field Strength1.5T. AssessmentData were collected and an appropriateness category was assigned for each cardiac MRI. Statistical TestsRates of major cardiac risk factors were compared between those undergoing cardiac MRIs pre- and post-AUC using the chi-square and the Mann-Whitney tests for categorical and continuous variables, respectively. Appropriateness classification was compared pre- and post-AUC publication using the chi-square test. ResultsThere were no significant differences in the prevalence of major cardiovascular risk factors before and after publication of the AUC. 95.5% of all cardiac MRIs were appropriate based on the AUC. Further, there was a significant difference when comparing the appropriateness classification before and after publication of the AUC (P=0.0003), potentially associated with annual cost savings of similar to $14.8 million. Data ConclusionWe report a very high percentage of appropriate use of cardiac MRI and a significant increase in the proportion of tests classified as appropriate after AUC publication. Level of Evidence: 3 Technical Efficacy: Stage 5 J. Magn. Reson. Imaging 2019;49:e132-e138.