Interventional cardiology

MSAC to considering MBS item for ‘gold standard’ myocarditis diagnosis

A bid for a Medicare item to fund cardiac MRI in the diagnosis of myocarditis has been made by CSANZ, which cites a growing need due to COVID-19 vaccinations.

While myocardial biopsy is already subsidised on the MBS, the society argues it could be replaced with cardiac MRI in up to 80% of patients presenting with acute cardiomyopathy – ending the requirement for an invasive procedure and possible hospital stay.

Beyond the safety and cost benefits, it says MRI is also more sensitive than biopsy for the diagnosis of acute myocarditis given the entire heart is assessed.

And it is also the gold standard in patients presenting as a mimic of an acute coronary syndrome, who currently have to undergo invasive angiography or cardiac CT for diagnosis, according to the society.

A result of the current diagnostic algorithm is that patients may be falsely diagnosed with an acute coronary syndrome when the real diagnosis is acute myocarditis, CSANZ said in an application to the Medical Services Advisory Committee.

“These patients may then be inappropriately treated with lifelong secondary preventive therapies for coronary artery disease which is minor and asymptomatic (as their symptoms were secondary to acute myocarditis),” it said.

“Therefore, a diagnostic pathway incorporating cardiac MRI will lead to greater diagnostic certainty which will likely to lead to more appropriate delivery of therapies.”

In the application filed earlier this year, the society said there was an increasing need for diagnostic tools to identify the inflammatory condition.

This reflected evidence that in those receiving an mRNA COVID-19 vaccine, the incidence of vaccine associated myocarditis may be as high as 1 in 25,000 vaccine doses, CSANZ said.

Its background incidence was lower, at approximately 30 per 100,000-person years, most frequently occurring following viral infection including COVID-19, the society added.

However, it also occurred after bacterial, fungal and parasitic infections, as a complication of autoimmune disorders or a consequence of drug reactions or environmental toxins.

With each study expected to take between 45 minutes and one hour, an appropriate rebate would be $855.20, CSANZ said.

It proposed that in, order to be eligible under Medicare, patients would need to be referred by a cardiologist or other consultant physician, with the scan performed by an accredited cardiac MRI provider.

There were currently 144 such providers accredited in Australia, including 84 cardiologists and 60 radiologists, the society said.

Proposed item descriptor:

MRI–scan of cardiovascular system for the assessment of myocardial structure and function and characterisation, if the service is requested by a consultant physician who has assessed the patient, and the request for the scan indicates:

(a) the patient has suspected myocarditis and would otherwise require myocardial biopsy or coronary angiography to confirm the diagnosis; OR

(b) the patient has suspected myocarditis after receiving a mRNA COVID-19 vaccine with symptom onset within 21 days of a mRNA COVID-19 vaccine administration; AND

(c) the results from the following examinations are inconclusive to form a diagnosis of myocarditis:

(i) echocardiogram; and

(ii) troponin; and

(iii) chest X-ray.

(R) (Anaes.) (Contrast)

Fee: $855.20

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