Temporal Trends In Non-Invasive Diagnostic Tests For Ischemic Heart Disease Among Us Adults Age 64 Years Or Younger: Results From The Marketscan Survey, 2010-2018

Introduction: Heart disease is the leading cause of death in the U.S. Ischemic heart disease (IHD) accounts for two thirds of heart disease deaths. Non-invasive cardiovascular tests (NITs) are often the first step to establish an IHD diagnosis. Methods: We analyzed 2010-2018 IBM® MarketScan® Commercial Databases. NITs including exercise ECG, stress echocardiography, CT coronary artery calcification score (CT-CAC), single-photon emission computerized tomography (SPECT), cardiac CT angiography (CTA), nuclear positron emission tomography/myocardial perfusion imaging (PET/MPI), stress MRI, were identified using current procedural terminology (CPT) codes. IHD using ICD 9/10 codes (410-414, 429.2/I20-I25) and chest pain (786.59/R07.89) or unspecified chest pain (786.50/R07.9) were identified. The 2000 Census population was used to calculate the age standardized prevalence. Results: The data included 20,726,587 individuals (48.1% men, mean age (standard deviation) of 49.1 (13.5) years), among which 67,339 had a diagnosis of IHD or chest pain in 2018. The age standardized prevalence of the overall population that had at least one of the 7 tests is 1.60% in 2018, down from 2.47% in 2010. The responding prevalence for those with IHD or chest pain was 54.3% in 2018 and 61.6% in 2010. Exercise ECG was the most utilized test for the overall population: 0.94% in 2018 down from 1.31% in 2010; SPECT was second most often used with 0.75% in 2018 and 1.24% in 2010. However, SPECT was the most often utilized test among those with CHD or chest pain: 38.2% in 2018, down from 45.0% in 2010, and exercise ECG second most often with 32.6% in 2018 and 34.9% in 2010. An increase in use of CT-CAC, PET/MPI, and CTA tests was observed since 2010, but the prevalence of all were low in 2018. 0.02%. 0.01%, and 0.04% for the overall population and 0.20%, 0.95% and 3.20% for those with IHD or chest pain, respectively. Conclusions: Almost 2% of the general younger US adult population and over half of those with IHD or chest pain had undergone at least one of 7 NITs in 2018. While the utilization of overall NITs for both the general population and those with IHD or chest pain has declined since 2010, it has increased for CT-CAC, PET/MPI, and CTA but still less than 1% for CT-CAC and PET/MPI..