STATIN RATES ONE YEAR AFTER OPPORTUNISTIC SCREENING FOR CORONARY ARTERY CALCIUM ON NON-GATED CHEST CT SCANS (NOTIFY-EXTEND PROJECT)

Therapeutic Area

ASCVD /CVD Risk Reduction

Background

Cardiovascular disease prevention is suboptimal, especially among high-risk individuals who would benefit from lipid-lowering therapy. The NOTIFY-1 project demonstrated that screening for incidental coronary artery calcium (CAC) on non-gated chest computed tomography (CT) scans with a deep-learning algorithm, followed by patient and clinician notification, significantly increased statin prescriptions at 6 months. NOTIFY-EXTEND assessed statin initiation and persistence in a larger sample at 12 months post-notification.

Methods

The NOTIFY-1 project identified Stanford Healthcare patients without prior diagnosis of atherosclerotic cardiovascular disease (ASCVD) or statin therapy who underwent non-gated, non-contrast chest CT. Patients with CAC were identified via a deep-learning algorithm and initially randomized to notification (“early notification,” including their primary care clinicians) or usual care. Following completion of the project, patients in usual care who had not started statin therapy received a similar notification (“delayed notification”). The primary outcome of this follow-up study was statin prescription rates at 12 months. Secondary outcomes included discontinuation rates, cholesterol levels, cardiovascular testing, and outpatient encounters.

Results

There were 163 patients that received CAC notification, including 86 with early notification and 77 with delayed notification. Following notification, 75 participants (46%) were prescribed a statin within 6 months and 86 participants (53%) within 12 months. There were 117 participants (72%) that were either prescribed a statin or had a documented discussion regarding statin therapy within 12 months post-notification. Of participants prescribed a statin, 5% discontinued statin therapy within the 12-month follow-up period.

There was a significant decrease in low-density lipoprotein cholesterol (115.6 mg/dL to 90.6 mg/dL; p<0.001) and triglyceride (106.2 mg/dL to 91.3 mg/dL; p=0.003) levels from baseline to 12 months post-notification. Additionally, we observed increased healthcare utilization in the post-notification period (Table 1).

Conclusions

Opportunistic screening and notification of CAC from non-gated chest CTs was associated with an increase in statin prescription rates that persisted at 12 months post-notification. Opportunistic screening for incidental CAC may be a powerful approach to motivating statin initiation and persistence.