An Unfolding View of Imaging

ver the past decade, private and public payers have used a barrage of programs and policies to restrain growth and excessive utilization patterns within cardiovascular imaging. Dramatic cuts in payments, prior authorization programs, and reliance on proprietary algorithms to define appropriate use are now standard policies to guide reimbursement for the majority of cardiovascular imaging. There is a general perception among most within the cardiovascular community that these draconian policies to constrain growth were born of the overuse of cardiovascular imaging. Even a recent statement from the American College of Cardiology focused attention on the perceptibly high rates of cardiovascular imaging and the need for greater evidence to guide the development of clinical practice guidelines and appropriate use criteria (2). But is perception reality? In this issue of iJACC, Farmer et al. (3) examine cardiovascular imaging utilization patterns from a large registry of patients presenting for de novo heart failure hospitalization. What is intriguing from this report is that unexpectedly low rates of imaging utilization were documented for this high-risk cohort of patients with heart failure. The first question that must be asked is how this could be, given all of the discussion about egregious and excessive imaging utilization practices.