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Circulation ：Volume 113, Issue 3; January 24, 2006

Temporal Trends in the Utilization of Diagnostic Testing and Treatments for Cardiovascular Disease in the United States, 1993–2001
Background— Rates of invasive testing and treatment for coronary artery disease have increased over time. Less is known about trends in the utilization of noninvasive cardiac testing for coronary artery disease. The objective of this study was 2-fold: to explore temporal trends in the utilization of noninvasive and invasive cardiac services in relation to changes in the prevalence of cardiac disease, and to examine whether temporal increases have been targeted to potentially underserved populations.
Methods and Results— We performed an annual cross-sectional population-based study of Medicare patients from 1993 to 2001. We identified stress testing, cardiac catheterization, and revascularization procedures, as well as hospitalizations for acute myocardial infarction, during each year and calculated population-based rates for each using the total fee-for-service Medicare population as the denominator and adjusting for age, gender, and race. We observed marked growth in the utilization rates of cardiac services over time, with relative rates nearly doubling for most services. Acute myocardial infarction hospitalization rates have remained stable over the study period. Although rates of all procedures except coronary artery bypass increased in all subgroups, differences in rates of cardiac testing and treatment between nonblack men and other subgroups persisted over time.
Conclusions— Temporal increases in the use of noninvasive and invasive cardiac services are not explained by changes in disease prevalence and have not succeeded in narrowing preexisting treatment differences by gender and race. Such increases, although conferring benefit for some, may expose others to risk and cost without benefit.

1993~2001年诊断性检测和治疗在美国心血管疾病中应用的短期趋势

背景 用于冠状动脉疾病的创伤性检查和治疗的比例逐年增加，对于非创伤性检查在冠脉疾病中的应用趋势相对了解较少。本研究的研究目的有二：第一，探索随着心血管病的流行，创伤性和非创伤性诊疗措施的短期应用趋势；第二，研究这些诊疗措施使用率的短期增长是否已经瞄准了那些潜在的还未使用的人群。

方法和结果 我们选择1993～2001年的医疗保险病人，进行每年一次的有代表性的基于人群的研究。观察每年负荷试验、心导管检查、血运重建术以及急性心肌梗死的住院情况，以所有进行上述检查的医疗保险人群作为分母，调整年龄、性别和种族后，计算基于总体的率。我们发现随着时间变化，心脏病的诊疗措施的使用率有着显著增长，大多数措施的使用率增长了近一倍。本研究期间，急性心肌梗死的住院率保持稳定。虽然除了冠状动脉旁路搭桥术外，其他诊疗措施的应用在所有亚组中都有显著增加，但在非黑人男性和其他亚组之间心脏病检测和治疗措施的使用率方面仍然存在着差别。

结论 短期增加的创伤性和非创伤性心血管诊疗手段的使用率，不能完全用心血管病流行趋势的变化来解释。以前在治疗方面就存在的不同性别和种族间的差别也没有得到减小。上述诊疗手段使用率的增长，对部分人是有益的，但是也许会使另外一部分人暴露于危险因素中，并且得不到应有的费用－效益比。