Effect of Coronary Computed Tomography Angiography-Derived Fractional Flow Reserve on Physicians’ Clinical Behavior ― Differences Between Sites With and Without Appropriate Use Criteria as Designated by the Japanese Reimbursement System ―
Open Access
- 10 July 2020
- journal article
- Published by Japanese Circulation Society in Circulation Reports
- Vol. 2 (7), 364-371
- https://doi.org/10.1253/circrep.cr-20-0038
Abstract
Background:Coronary computed tomography angiography (CCTA)-derived fractional flow reserve (FFRCT) is an established tool for identifying lesion-specific ischemia that is now approved for use by the Japanese insurance system. However, current clinical reimbursement is strictly limited to institutions with designated appropriate use criteria (AUC). This study assessed differences in physicians’ behavior (e.g., use and interpretation of FFRCT, final management) according to Japanese AUC and non-AUC site designation. Methods and Results:Of 5,083 patients in the ADVANCE Registry, 1,829 from Japan were enrolled in this study. Physicians’ behavior after interrogating CCTA and FFRCTwas analyzed separately according to AUC and non-AUC site designation. Compared with AUC sites, patients referred for FFRCTfrom non-AUC sites had a higher rate of negative FFRCT, less severe anatomic stenosis, and a slightly lower rate of management plan reclassification (51.2% vs. 61.3%), with near-identical utility in both groups. Actual care corresponded equally well to post-FFRCTplans in both groups. The likelihood of revascularization for positive or negative FFRCTwas similar between the 2 groups. Importantly, AUC and non-AUC sites were equally unlikely to revascularize patients with negative FFRCTand stenosis >50% or patients with positive FFRCTand stenosis Conclusions:Compared with AUC sites, non-AUC sites had lower disease burden and reclassification of management plans, but nearly identical clinical integration. Actual care corresponded equally well to post-FFRCTrecommendations at both sites.Keywords
This publication has 8 references indexed in Scilit:
- 1-Year Impact on Medical Practice and Clinical Outcomes of FFRCT The ADVANCE RegistryJACC: Cardiovascular Imaging, 2020
- Clinical Impact of Coronary Computed Tomography Angiography-Derived Fractional Flow Reserve on Japanese Population in the ADVANCE RegistryCirculation Journal, 2019
- Real-world clinical utility and impact on clinical decision-making of coronary computed tomography angiography-derived fractional flow reserve: lessons from the ADVANCE RegistryEuropean Heart Journal, 2018
- Coronary CT Angiographic and Flow Reserve-Guided Management of Patients With Stable Ischemic Heart DiseaseJournal of the American College of Cardiology, 2018
- Rationale, design and goals of the HeartFlow assessing diagnostic value of non-invasive FFR CT in Coronary Care (ADVANCE) registryJournal of Cardiovascular Computed Tomography, 2016
- 1-Year Outcomes of FFRCT-Guided Care in Patients With Suspected Coronary DiseaseJournal of the American College of Cardiology, 2016
- Diagnostic Performance of Noninvasive Fractional Flow Reserve Derived From Coronary Computed Tomography Angiography in Suspected Coronary Artery DiseaseJournal of the American College of Cardiology, 2014
- Diagnosis of Ischemia-Causing Coronary Stenoses by Noninvasive Fractional Flow Reserve Computed From Coronary Computed Tomographic Angiograms: Results From the Prospective Multicenter DISCOVER-FLOW (Diagnosis of Ischemia-Causing Stenoses Obtained Via Noninvasive Fractional Flow Reserve) StudyJournal of the American College of Cardiology, 2011