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1998 Presentations for the Poster and Vignette Sessions
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FIRST­TIME REFERRALS FOR MYOCARDIAL PERFUSION SCANS TO DETECT ISCHEMIA ARE USED MORE COST­EFFECTIVELY BY CARDIOLOGISTS THAN BY FAMILY PRACTITIONERS. S. Zaidi and R. Gal. Cardiovascular Disease Section, Department of Medicine Milwaukee Heart Institute, Milwaukee WI.

To determine if first­time referrals for SPECT myocardial perfusion stress scans being used cost­effectively, our nuclear cardiology laboratory retrospectively studied a total of 5,061 consecutive patients who were referred by either cardiologists (3900 patients) or family practitioners (1161 patients). Indications for the scan were chest pain or similar symptoms suggestive of active coronary artery disease. Either exercise or pharmacologic stress tests were performed. Test findings suggestive of ischemia were defined as an abnormal diffuse or regional perfusion pattern after stress that improved with rest.

Our comparison showed that patients referred by cardiologists and those referred by family practitioners were similar in age (62.3 yrs vs. 63.2 yrs) (P=.07) and that men in both groups were more likely to have findings of ischemia than females: 32.9% vs. 23.3% for those referred by cardiologists; 28.8% vs. 20.0% for those referred by family practitioners. For each group, the gender difference was statistically significant (P=.001). Regardless of gender, SPECT perfusion tests were positive for ischemia more often in patients referred by cardiologists; this difference was also statistically significant (P<.001).

Conclusion: Our study showed that patients referred for a first­time SPECT myocardial perfusion scan are found to have a significantly higher rate of ischemia when the referral is made by a cardiologist than by a family practitioner, indicating that family practitioners should consider whether to refer a patient to a cardiologist or to refer directly for a myocardial perfusion scan.

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