Incidental Coronary Artery Calcium: Opportunistic Screening of Previous Nongated Chest Computed Tomography Scans to Improve Statin Rates (NOTIFY-1 Project)

Author:

Sandhu Alexander T.1234ORCID,Rodriguez Fatima1254ORCID,Ngo Summer1ORCID,Patel Bhavik N.6,Mastrodicasa Domenico47,Eng David89,Khandwala Nishith89,Balla Sujana10,Sousa Doug11,Maron David J.154ORCID

Affiliation:

1. Division of Cardiovascular Medicine, Department of Medicine (A.T.S., F.R., S.N., D.J.M.), Stanford University, CA.

2. Center for Digital Health, Department of Medicine (A.T.S., F.R.), Stanford University, CA.

3. Veterans Affairs Palo Alto Healthcare System, CA (A.T.S.).

4. Stanford Cardiovascular Institute (A.T.S., F.R., D.M., D.J.M.), Stanford University School of Medicine, CA.

5. Stanford Prevention Research Center, Department of Medicine (F.R., D.J.M.), Stanford University, CA.

6. Department of Radiology, Mayo Clinic Arizona, Phoenix (B.N.P.).

7. Department of Radiology (D.M.), Stanford University School of Medicine, CA.

8. Department of Computer Science (D.E., N.K.), Stanford University School of Medicine, CA.

9. Bunkerhill Health, Palo Alto, CA (D.E., N.K.).

10. Department of Internal Medicine, University of California San Francisco-Fresno (S.B.).

11. Patient Representative, Hollister, CA (D.S.).

Abstract

Background: Coronary artery calcium (CAC) can be identified on nongated chest computed tomography (CT) scans, but this finding is not consistently incorporated into care. A deep learning algorithm enables opportunistic CAC screening of nongated chest CT scans. Our objective was to evaluate the effect of notifying clinicians and patients of incidental CAC on statin initiation. Methods: NOTIFY-1 (Incidental Coronary Calcification Quality Improvement Project) was a randomized quality improvement project in the Stanford Health Care System. Patients without known atherosclerotic cardiovascular disease or a previous statin prescription were screened for CAC on a previous nongated chest CT scan from 2014 to 2019 using a validated deep learning algorithm with radiologist confirmation. Patients with incidental CAC were randomly assigned to notification of the primary care clinician and patient versus usual care. Notification included a patient-specific image of CAC and guideline recommendations regarding statin use. The primary outcome was statin prescription within 6 months. Results: Among 2113 patients who met initial clinical inclusion criteria, CAC was identified by the algorithm in 424 patients. After chart review and additional exclusions were made, a radiologist confirmed CAC among 173 of 194 patients (89.2%) who were randomly assigned to notification or usual care. At 6 months, the statin prescription rate was 51.2% (44/86) in the notification arm versus 6.9% (6/87) with usual care ( P <0.001). There was also more coronary artery disease testing in the notification arm (15.1% [13/86] versus 2.3% [2/87]; P =0.008). Conclusions: Opportunistic CAC screening of previous nongated chest CT scans followed by clinician and patient notification led to a significant increase in statin prescriptions. Further research is needed to determine whether this approach can reduce atherosclerotic cardiovascular disease events. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT04789278.

Funder

HHS | NIH | National Heart, Lung, and Blood Institute

American Heart Association

Doris Duke Charitable Foundation

Stanford University

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Physiology (medical),Cardiology and Cardiovascular Medicine

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