Overall impact of outpatient stress cardiac magnetic resonance (CMR) imaging on clinical care is independent of appropriate use criteria

Background Stress cardiac-magnetic-resonance (CMR) imaging can provide important diagnostic and prognostic information in patients with known or suspected coronary artery disease. However, given the rising costs of imaging, there is increasing pressure to provide evidence for direct additive impact on clinical care. Appropriate use criteria (AUC) have been developed by professional organizations as a response to rising costs, with the goal of optimizing test-patient selection. Consequently, the AUC are now increasingly used by third-party-payers to assess reimbursement. However, these criteria were created by expert consensus with limited systematic validation. The aim of this study was to determine whether the AUC can predict rates of active change in clinical care resulting from stress CMR.