Defining Quality in Cardiovascular Imaging: A Scientific Statement From the American Heart Association

Abstract

The aims of the current statement are to refine the definition of quality in cardiovascular imaging and to propose novel methodological approaches to inform the demonstration of quality in imaging in future clinical trials and registries. We propose defining quality in cardiovascular imaging using an analytical framework put forth by the Institute of Medicine whereby quality was defined as testing being safe, effective, patient-centered, timely, equitable, and efficient. The implications of each of these components of quality health care are as essential for cardiovascular imaging as they are for other areas within health care. Our proposed statement may serve as the foundation for integrating these quality indicators into establishing designations of quality laboratory practices and developing standards for value-based payment reform for imaging services. We also include recommendations for future clinical research to fulfill quality aims within cardiovascular imaging, including clinical hypotheses of improving patient outcomes, the importance of health status as an end point, and deferred testing options. Future research should evolve to define novel methods optimized for the role of cardiovascular imaging for detecting disease and guiding treatment and to demonstrate the role of cardiovascular imaging in facilitating healthcare quality.

Keywords: AHA Scientific Statements; cardiac imaging techniques.

Conflict of interest statement

The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.

© 2017 American Heart Association, Inc.

Figures

Figure 1

Key indicators of quality in cardiovascular imaging.

Figure 2

Imager care coordination.

Figure 3

Hierarchy of cardiovascular imaging evidence.

Figure 4

Critical components of high-quality cardiovascular imaging evidence.

Figure 5

Refining appropriate end points for cardiovascular imaging research, including health status and symptoms, and associated sequelae, including variation in symptoms and risk of major coronary artery disease events. ACS indicates acute coronary syndrome.

Figure 6

Life cycle of evidence development for quality standards for cardiovascular imaging.