Prevalence of CAC Scoring in Patients With Known Coronary Artery Disease: A Cohort Study on Choosing Wisely

IF 2.1 4区医学 Q3 HEALTH CARE SCIENCES & SERVICES

Journal of evaluation in clinical practice Pub Date : 2025-06-29 DOI:10.1111/jep.70185

Sarah J. Murphy, David E. Winchester

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引用次数: 0

Abstract

Background

Coronary artery calcium (CAC) scoring plays a role in risk assessment for presence of atherosclerotic coronary heart disease (CHD). Among patients with known CHD, CAC has little or no value. Performing CAC on CHD patients is discouraged by ACC/AHA guidelines and the Choosing Wisely campaign. The extent to which this occurs in clinical practice is not well described.

Methods

We evaluated all UF Health patients since 2011 with known CHD who later underwent CAC scoring. We used our Integrated Data Repository to identify the cohort based on International Classification of Diseases and Current Procedural Terminology codes. Data from patient demographics, past medical history, CAC scoring results, ordering provider information and subsequent clinical management were recorded into a custom REDCap database for qualitative analysis. No prespecified statistical plan was performed as the investigation was intended as descriptive.

Results

Upon reviewing all patients with known CHD, we found only 19 instances over 12 years where CAC scoring was ordered. Among these, 14 were men and 5 were women. A large percentage had a past medical history of DM (9, 47.4%) and hypertension (15, 78.9%) with a subclinical CHD diagnosis (17, 89.5%). Statin therapy was already initiated for 13 (68.4%). Most of the CAC scoring tests were ordered by cardiology attendings (10, 52.6%), and the justification most frequently provided was for risk stratification in patients with known CHD. Often (78.9%), there was no significant change in patient management or a slight alteration in medication therapy. One case resulted in percutaneous intervention.

Conclusions

CAC scoring was rarely ordered among patients with known CHD over a 12-year span. Professional society efforts towards encouraging high-value care may wish to consider more high-impact recommendations in the future.

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已知冠状动脉疾病患者CAC评分的流行：一项明智选择的队列研究

背景冠状动脉钙（CAC）评分在动脉粥样硬化性冠心病（CHD）存在的风险评估中起着重要作用。在已知冠心病的患者中，CAC几乎没有价值。ACC/AHA指南和明智选择运动不鼓励对冠心病患者进行CAC。这种情况在临床实践中发生的程度尚未得到很好的描述。方法：我们评估了2011年以来所有患有已知冠心病的UF Health患者，这些患者后来进行了CAC评分。我们使用我们的集成数据存储库根据国际疾病分类和现行程序术语代码来确定队列。患者人口统计数据、既往病史、CAC评分结果、订购提供者信息和随后的临床管理数据被记录到定制的REDCap数据库中进行定性分析。由于调查是描述性的，因此没有执行预先指定的统计计划。结果在回顾所有已知的冠心病患者后，我们发现在12年中只有19例患者进行了CAC评分。其中男性14人，女性5人。有糖尿病（9.47.4%）和高血压（15.78.9%）病史的患者占很大比例，并有亚临床冠心病诊断（17.89.5%）。13例（68.4%）已经开始他汀类药物治疗。大多数CAC评分测试是由心脏病科医生（10.52.6%）安排的，最常见的理由是对已知冠心病患者进行风险分层。通常情况下（78.9%），患者管理没有明显改变，药物治疗也没有轻微改变。1例经皮介入治疗。结论：已知冠心病患者在12年内很少进行CAC评分。专业协会鼓励高价值护理的努力可能希望在未来考虑更多高影响力的建议。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of evaluation in clinical practice 医学-卫生保健

CiteScore

4.80

自引率

4.20%

发文量

143

审稿时长

3-8 weeks

期刊介绍： The Journal of Evaluation in Clinical Practice aims to promote the evaluation and development of clinical practice across medicine, nursing and the allied health professions. All aspects of health services research and public health policy analysis and debate are of interest to the Journal whether studied from a population-based or individual patient-centred perspective. Of particular interest to the Journal are submissions on all aspects of clinical effectiveness and efficiency including evidence-based medicine, clinical practice guidelines, clinical decision making, clinical services organisation, implementation and delivery, health economic evaluation, health process and outcome measurement and new or improved methods (conceptual and statistical) for systematic inquiry into clinical practice. Papers may take a classical quantitative or qualitative approach to investigation (or may utilise both techniques) or may take the form of learned essays, structured/systematic reviews and critiques.