Ultimately, however, the company found that “the guidelines did not cross the threshold that we felt was necessary to be truly patient-centered.”
“We want to be clear,” the authors wrote. “There are a lot of great, evidence-based recommendations in the new guideline. There are also some disturbing recommendations and omissions that the ASNC ultimately cannot stand.
So what were the group’s concerns?
First, ASNC representatives were concerned that fractional flow reserve computed tomography (FFR-CT) was given “too much of a role” in the outcome document. The modality has its advantages, they wrote, but “its overall diagnostic accuracy is still low” and its availability may be limited due to only one company providing the FFR-CT. Additionally, the authors said they were “surprised” that more time was not given to detail “the cost or limitations of FFR-CT”.
Another big concern among ASNC representatives was that the guideline did not put enough emphasis on patient-oriented imaging. Selecting the right exam for the right patient is crucial, they wrote, and that decision often comes down to details like patient preference or availability. ASNC members felt that this was not sufficiently addressed in document AHA / ACC.
The group also said it felt there was not enough detail on the benefits of multimodality testing. And the modalities of stress testing, they wrote, “should not be bundled.”
“All stress imaging tests have their unique advantages and limitations, and there are important differences in sensitivity and specificity, as well as strengths and limitations between exercise ECG, echo. effort, the SPECT MPI, the PET MPI and the exercise MRI, ”they wrote.
Click here to read the group’s full assessment of the Zenodo Open Access Server Guidelines.