Abstract Physician certification and laboratory accreditation are two major components of quality assurance and the optimal performance of a nuclear cardiology program. Physician certification is a process by which a physician receives professional recognition for having achieved the necessary knowledge, skills, and experience in a specific field. Different pathways for certification are available, often based on prerequisites depending on the candidate’s training background, experience, and location of training. Laboratory accreditation is an analytical process that provides stringent national standards to ensure a high level of quality, hopefully with a direct impact on patient care. The process may usually be completed in 3 to 6 months and is valid for up to 3 years. Accreditation may be done via national CMS-certified agencies, each with individual established rigorous criteria. Accreditation is an independent peer-review process with the objective of overall improvement in the quality of the nuclear laboratory. Accreditation is an ongoing effort striving for uninterrupted value to confirm adherence to high-quality care.

This document from the American Society of Nuclear Cardiology develops metrics for the assessment of quality for laboratories that perform cardiac amyloid radionuclide imaging. These metrics are based on clinical guidelines, appropriate use criteria, information and position statements, and expert opinion. The document introduces 15 quality metrics that address current gaps in care organized around 4 axes: A) Appropriate indications; B) Patient experience and workflow; C) Instrumentation and protocols; and D) Interpretation and reporting. With the increasing use of imaging for cardiac amyloid, it is imperative that our laboratories maintain a high level of quality to preserve the value that imaging provides to patients. Laboratories should perform imaging in appropriately selected patients avoiding low-value imaging. Proper education should be provided to patients prior to performing testing, timely access to testing must be available, and periodic assessment of patient experience and satisfaction should be the norm. Strict adherence to established protocols with periodic assessment of laboratory quality control is essential. Laboratory studies to rule out plasma cell dyscrasia should be performed in all patients suspected of having cardiac amyloidosis. Crucially, interpretation should be based on SPECT rather than planar imaging in all patients. The study report should include sufficient technical details to allow for proper interpretation of study findings and its conclusion should be clear and unambiguous to guide clinical management. Laboratories can use data derived from these metrics to identify areas of deficiency and introduce quality improvement initiatives, which will ultimately improve patient outcomes.

Purpose:To characterize the recovery of diagnostic cardiovascular procedure volumes in U.S. and non-U.S. facilities in the year following the initial COVID-19 outbreak.Materials and Methods:The International Atomic Energy Agency (IAEA) coordinated a worldwide study called the IAEA Noninvasive Cardiology Protocols Study of COVID-19 2 (INCAPS COVID 2), collecting data from 669 facilities in 107 countries, including 93 facilities in 34 U.S. states, to determine the impact of the pandemic on diagnostic cardiovascular procedure volumes. Participants reported volumes for each diagnostic imaging modality used at their facility for March 2019 (baseline), April 2020, and April 2021. This secondary analysis of INCAPS COVID 2 evaluated differences in changes in procedure volume between U.S. and non-U.S. facilities and among U.S. regions. Factors associated with return to prepandemic volumes in the United States were also analyzed in a multivariable regression analysis.Results:Reduction in procedure volumes in April 2020 compared with baseline was similar for U.S. and non-U.S. facilities (-66% vs -71%, P = .27). U.S. facilities reported greater return to baseline in April 2021 than did all non-U.S. facilities (4% vs -6%, P = .008), but there was no evidence of a difference when comparing U.S. facilities with non-U.S. high-income country (NUHIC) facilities (4% vs 0%, P = .18). U.S. regional differences in return to baseline were observed between the Midwest (11%), Northeast (9%), South (1%), and West (-7%, P = .03), but no studied factors were significant predictors of 2021 change from prepandemic baseline.Conclusion:The reductions in cardiac testing during the early pandemic have recovered within a year to prepandemic baselines in the United States and NUHICs, while procedure volumes remain depressed in lower-income countries.Keywords: SPECT, Cardiac, Epidemiology, Angiography, CT Angiography, CT, Echocardiography, SPECT/CT, MR Imaging, Radionuclide Studies, COVID-19, Cardiovascular Imaging, Diagnostic Cardiovascular Procedure, Cardiovascular Disease, Cardiac Testing Supplemental material is available for this article. © RSNA, 2023.

In patients with congestive heart failure (CHF), remote hemodynamic monitoring can reduce heart failure exacerbation and mortality. In this study, we compared the effective-ness of remote hemodynamic monitoring with that of standard care in the management of patients with CHF. The remote monitoring group included 7,733 patients, and the control group included 7,567 patients. Chi-square test and I-square statistics were used to assess heterogeneity. Risk ratios (RRs) were calculated using fixed-effects and random-effects methods to determine the risk of all-cause hospitalization and CHF-related hospitalization (primary outcomes) and all-cause mortality and device outcomes (secondary outcomes). Pooled findings indicated a 7% lower risk of all-cause hospitalization in the remote moni-toring group than that in the control group (RR 0.93, 95% confidence interval [CI] 0.89 to 0.98, p = 0.004). The results also revealed a 32% lower risk of CHF-related hospitalization in the remote monitoring group than that in the control group (RR 0.68, 95% CI 0.65 to 0.71, p <0.001). No statistically significant differences were noted between the groups in terms of all-cause mortality (RR 0.97, 95% CI 0.87 to 1.07, p = 0.53) and device outcomes (RR 1.23 95% CI 0.92 to 1.65, p = 0.16). These results provided evidence regarding the comparable effectiveness of remote CHF monitoring and routine care. The current evi-dence is insufficient to introduce remote hemodynamic CHF monitoring; however, our results suggest that the integration of telemonitoring systems with routine medical man-agement may improve heart failure care. (c) 2023 Elsevier Inc. All rights reserved. (Am J Cardiol 2023;192:79-87)