Cardiac Stress Imaging Not Meeting Appropriate Use Criteria: Preoperative Evaluation in Low-Risk Surgery Patients
Percentage of stress single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI), stress echocardiogram (ECHO), cardiac computed tomography angiography (CCTA), or cardiac magnetic resonance (CMR) performed in low risk surgery patients 18 years or older for preoperative evaluation during the 12-month reporting period.
ACP does not support QPP measure 322: "Cardiac Stress Imaging Not Meeting Appropriate Use Criteria: Preoperative Evaluation in Low-Risk Surgery Patients." While this measure promotes appropriate use of cardiac stress imaging in low-risk surgery patients and cites American College of Cardiology/American Heart Association (ACC/AHA) clinical recommendations on perioperative evaluation of patients undergoing non-cardiac surgery to form the basis of the measure, developers do not cite a performance gap. Additionally, the denominator population is not specified for individual clinician use. The denominator population is correctly specified to evaluate quality performance at the cardiac lab level. Also, clinicians may misinterpret the measure as currently written. Developers should consider revising the numerator to include cardiac stress images performed within 30 days preceding low-risk, non-cardiac surgery and the denominator specifications to include asymptomatic patients undergoing low-risk surgery.