Trends in Palliative Care Use in Veterans With Severe Heart Failure Using a Large National Cohort

Abstract

Methods | Using the 20% random sample of fee-for-service Medicare beneficiaries aged 65 years or older in the carrier and enrollment data from 2008 through 2012, we assessed 99m Tc radiotracer use in the approximately 2 million cardiac stress tests with SPECT-MPI performed during these years, using codes A9500 and A9502 to identify 99m Tc-labeled radiotracers. We calculated population-based rates of SPECT-MPI as well as rates for alternative testing modalities (stress echocardiography, computed tomography coronary angiography, and positron emission tomography-MPI) and downstream cardiac catheterization less than 90 days after index testing. We identified a priori the 6-month shortage during March through August 2010 due to shutdowns at the Petten High Flux and Chalk River Laboratories reactors, the 2 major producers of 99 Mo for the United States. We used descriptive statistics to document temporal trends. Multivariable logistic regression was used to estimate the odds of cardiac catheterization less than 90 days after SPECT-MPI depending on radiotracer use after adjusting for age, sex, and race.