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

Cited by 21 articles. 订阅此论文施引文献 订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3