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November 8, 2012
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News for and about nuclear cardiology and cardiovascular imaging professionals

ASNC SmartBrief Special Report:
Best practices in cardiology
Two weeks ago, ASNC SmartBrief asked you to weigh in on the Choosing Wisely recommendations for clinical practice. This special report spotlights your responses as well as a conversation with Dr. Robert Hendel, who was involved in developing the recommendations. In addition, you'll find related news on best practices in medicine with a focus on continued improvement in nuclear cardiology, patient satisfaction and more.
  Clinical Practice 
  • PET, cardiac MR perform comparably in diagnosing CAD
    PET and cardiac MR were comparable in yielding myocardial perfusion reserve measurements that can help improve accuracy in diagnosing significant coronary artery disease, according to a study published in the Journal of the American College of Cardiology. PET-derived MPR showed 82% sensitivity and 87% specificity in predicting significant CAD, while the sensitivity and specificity for CMR-derived MPR are 82% and 81%, respectively. This strong concordance between the two methods "is important given the proven value of MPR PET for detection of CAD, prognostication, and assessment of the microcirculation," researchers said. CardiologyToday.com (10/18) LinkedInFacebookTwitterEmail this Story
 
  • Study: SPECT detected more perfusion defects than ECGs
    SPECT myocardial perfusion imaging is better at identifying perfusion defects and predicting cardiovascular death or morbidity compared with electrocardiograms, according to a study published in the European Heart Journal: Cardiovascular Imaging. Fifty percent of 650 patients with known or suspected heart disease who had normal findings from exercise ECGs showed abnormal results on SPECT MPI, the study said. Abnormal SPECT findings can be a strong predictor of death or major adverse cardiac events, researchers said. MedPage Today (free registration) (10/30) LinkedInFacebookTwitterEmail this Story
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Astellas is proud to support the American Society of Nuclear Cardiology. Visit www.us.astellas.com

  Patient Focus 
  • Patient surveys can help educate staff, improve practices
    Better-performing medical practices survey patients about their satisfaction and leverage the findings to examine and boost practice operations as well as educate staff and doctors regarding their behavior, according to a study by the Medical Group Management Association. The top multi-specialty practices posted lower overall operating costs as a percentage of total medical revenue compared with other practices. Healthcare Informatics online (10/22) LinkedInFacebookTwitterEmail this Story
  • Tool helps practices assess patient satisfaction
    The Medical Group Management Association and SullivanLuallin Group have unveiled the Patient Satisfaction Benchmarking Tool, which can be used by health group practices to create an accurate evaluation of patient satisfaction and find out how to boost it. The platform leverages an interface that allows users to compare survey scores of patients with the Consumer Assessment of Healthcare Providers and Systems' Clinician and Group Survey of the Agency for Healthcare Research and Quality. Healthcare Informatics online (10/25) LinkedInFacebookTwitterEmail this Story
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Astellas is proud to support the American Society of Nuclear Cardiology
Visit www.us.astellas.com

  Policy Pulse 
  • Medical groups suggest reforms on physician payment
    The American Medical Association, along with more than 100 medical groups representing states and specialties, sent a letter to the Senate Finance Committee outlining principles the societies said are needed to craft a new Medicare physician payment system. Initial steps include repeal of the sustainable growth rate formula followed by a series of reforms in delivery system, payment updates and physician rewards, the groups said. Bloomberg BNA (free content)/Health Care Daily Report (10/17) LinkedInFacebookTwitterEmail this Story
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  Spotlight on ASNC 
  • Choosing Wisely: A conversation about safety, stewardship and evidence-based practice
    ASNC took a leading role in this year's Choosing Wisely campaign by developing five targeted, evidence-based recommendations to support physicians in working with their patients to make wise choices about their care. ASNC SmartBrief spoke with Dr. Robert Hendel of the University of Miami Hospital and University of Miami Miller School of Medicine about the effort and its effect on clinical practice.

    Please explain the cascade of testing and possibly even procedures that can follow screening that may not be indicated for certain patients. What are the patient safety implications of that?

    A diagnostic evaluation usually starts with a low-risk, low-cost test. However, performing such a test may lead to additional testing or even treatment, even in the absence of clear benefit. This may cause both risk and cost to increase overall. A screening test, when abnormal, may lead to a confirmatory test, often with increased risks to the patient (undergoing stress testing, adverse effects to medications, exposure to radiation) and additional costs to society. However, a high-risk population may greatly benefit from the early detection of disease, but this should not be indiscriminately used for all patients, especially those at low risk for cardiovascular events.

    It's understandable why patients concerned about heart trouble might want to err on the side of overtesting, as opposed to missing an important diagnosis. How can clinicians educate patients about appropriate use and its relationship to patient safety? How do patients respond to these conversations?

    Campaigns such as "Choosing Wisely" help to make our patients informed consumers. The key is to prompt a dialog about care between patients and clinicians, weighing risks and benefits, with a discussion of supporting literature. Most patients simply want to be part of the conversation.

    Are conversations about appropriate use of imaging changing clinical practice?

    Absolutely, but these must be put into the context of both patient-centeredness and what medical literature and expert consensus supports. It is sometimes challenging to explain to a patient that not doing a test is often the best (and appropriate) approach.

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  • Has Choosing Wisely helped your practice decrease or eliminate tests that may not provide meaningful change in a patient's clinical management?
    Yes  61.11%
    No  27.78%
    N/A  11.11%
  • Has the guidance helped your practice customize a specific care plan for a specific patient?
    Yes  66.67%
    No  25.00%
    N/A  8.33%
  • Have Choosing Wisely recommendations helped your practice identify areas within your practice that will improve outcomes and reduce health care waste?
    Yes  76.92%
    No  15.38%
    N/A  7.69%
  • Has the initiative helped your practice encourage conversations about testing and procedures with your patients?
    Yes  75.00%
    No  16.67%
    N/A  8.33%
  
Product announcements appearing in SmartBrief are paid advertisements and do not reflect actual ASNC endorsements. The news reported in SmartBrief does not necessarily reflect the official position of ASNC.
 
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