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Background  Concern regarding overutilization of cardiac imaging has led to the development of appropriate use criteria ( AUC ). Myocardial perfusion imaging ( MPI ) is one of the most commonly used cardiac imaging modalities worldwide. Despite multiple iterations of AUC, there is currently no evidence regarding their real‐world impact on population‐based utilization rates of  MPI . Our goal was to assess the impact of the AUC on rates of  MPI  in Ontario, Canada. We hypothesized that publication of the AUC would be associated with a significant reduction in  MPI  rates.    Methods and Results  We conducted a retrospective cohort study of the adult population of Ontario from January 1, 2000, to December 31, 2015. Age‐ and sex‐standardized rates were compared from 4 different periods intersected by 3 published iterations of the AUC. Overall, 3 072 611  MPI  scans were performed in Ontario during our study period. The mean monthly rate increased from 14.1/10 000 in the period from January 2000 to October 2005 to 18.2/10 000 between November 2005 and June 2009. After this point in time, there was a reduction in rates, falling to a mean monthly rate of 17.1/10 000 between March 2014 and December 2015. Time series analysis revealed that publication of the 2009  AUC  was associated with a significant reduction in  MPI  rates ( P <0.001). This translated into ≈88 849 fewer  MPI  scans at a cost savings of ≈72 million Canadian dollars.    Conclusions  Our results reflect a potential real‐world impact of the 2009  MPI AUC  by demonstrating evidence of a significant effect on population‐based rates of  MPI .

journal of the american heart association

Impact of the Publication of Appropriate Use Criteria on Utilization Rates of Myocardial Perfusion Imaging Studies in Ontario, Canada: A Population‐Based Study