The American Heart Hospital Journal


Figure 1: Life Expectancy at Birth for Males, Females, and Both Genders in the US from 1970 to 20062


74 76 78 80 82


72 70 68 66


1966


1971 1976 1981 1986 1991 1996 2001 2006 Female


Both genders Males


Commentary


Figure 3: Frequency of Admissions for Myocardial Infarction per 100,000 FFS Medicare Beneficiary Years Between 2002 and 2007


1,350 1,800


450 900


0 2002 2003 2004 2005 2006 2007


Figure 4: Frequency of Admissions for Coronary Artery Disease per 100,000 FFS Medicare Beneficiary Years Between 2002 and 2007


Figure 2: Age-adjusted Death Rates for the Leading Causes of Death in the US from 1950 to 20062


1,000 1,200 1,400 1,600


800


600 400 200 0


1946 1956 1966 1976


All causes Chronic lower respiratory disease


Heart disease 1986 Cancer 1996 2006 Stroke Unintentional injuries


release of the American College of Cardiology (ACC)/ American Society of Nuclear Cardiology (ASNC) appropriateness guidelines the following year.10


Annual


decreases in myocardial perfusion imaging (MPI) from 2007 to 2009 were 2.1, 2.0, and 7%.9


This trend and the


worldwide shortage of Tc 99m could presage a near double- digit decrease in MPI in 2010.


Increasingly effective medical therapy in those with known CV disease and a more discriminating approach to the use of technology has also likely affected volume. A post-MI patient with a statin-related low-density lipoprotein of 60mg/dl on several other life-extending medications may well have a predicted annual event rate that a yearly MPI study is unlikely to influence. The increasingly used appropriateness criteria guidelines have incorporated such thinking. A greater focus on when and


Summer 2010


1,350 1,800


450 900


0 2002 2003 2004 2005 2006 2007


Figure 5: Estimated Total Number of Myocardial Perfusion Imaging Studies Performed in the US Between 1996 and 200910


4,000,000 5,000,000 6,000,000 7,000,000 8,000,000


3,000,000 2,000,000 1,000,000 0


how to use diagnostic testing has led us to be more discriminating in the selection of patients for interventional procedures and cardiac surgery, and has also led to more selective use of diagnostic procedures. More effective and longer-lasting interventions such as


The Decrease in the Volume of Work of Cardiologists 45


Deaths per 100,000 population


Life expectancy (years)


Number of procedures


Number of admissions


Number of admissions


1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009


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